Quality of life as a predicting factor for survival in 235 patients with inoperable hepatocellar carcinoma (HCC)

Abstract

4125 Background: Patients with inoperable HCC have a dismal prognosis. The objective of this study is to evaluate whether patient-reported baseline quality of life (QOL) measured by the EORTC QLQ-C30 instrument is predictive of survival for these patients. Methods: Two hundred thirty-five patients with inoperable HCC who were recruited into two separate randomized phase III clinical studies, based on palliative chemotherapy and palliative hormonal therapy respectively, were consented and had pre-treatment QOL assessment. EORTC QLQ-C30 scores and clinical variables at the time of study entry (age, sex, ECOG performance score, AFP, total bilirubin, alanine transaminase and albumin levels, prothrombin time, HBsAg positivity, presence of ascites, Child-Pugh’s grading of cirrhosis, vascular involvement, Okuda staging of HCC and entries into the two respective studies) were analyzed to identify factors that influenced survival by applying multivariate analysis. Independent prognosticators for survival were studied by Cox regression analysis. Results: Median survival of the 235 patient was 5.5 months (95% C.I. 4.2 - 6.5 months). Significant independent predictors of shorter survival were advanced Okuda staging (p= 0.0060; HR= 1.935), high baseline AFP (p= 0.0382; HR= 1.045) and total bilirubin (p= 0.0004; HR= 1.013), and worse QOL score in the appetite domain (p= 0.0136; HR= 1.006). Patients who were entered into the chemotherapy trial (p= 0.0006; HR= 0.544), those who scored better in the physical functioning domain (p= 0.0102; HR= 0.993) and the global QOL domain (p= 0.0171; HR= 0.991), were associated with longer survival. Conclusion: Baseline QOL is a predictor of survival for patients with inoperable HCC. When used along with traditional clinical factors, patient-reported baseline QOL assessment using the EORTC QLQ-C30 provides additional prognostic information. Acknowledgements: We thank Asia Pacific Hepatocellular Carcinoma Trials Group for providing QOL data for 77 patients from our centre who were consented into the Randomized Trial of High Dose Tamoxifen versus Placebo for the Treatment of Inoperable Hepatocellular Carcinoma. No significant financial relationships to disclose.