Quality-of-life measures as predictors of post-esophagectomy survival of patients with esophageal cancer.

Abstract

Improving survival after esophagectomy is an important issue in treating patients with esophageal cancer (EC). In addition to standard hospitalization management, periodic assessment of quality-of-life (QOL) measures may be useful to detect disease progression from patients' subjective reports. Therefore, this prospective longitudinal study was undertaken to identify prognostic factors for 3-year survival of EC patients after esophagectomy and to evaluate the impact of QOL measures on these prognostic factors. Patients with EC (n=67) who had a complete tumor resection and were alive 6months after esophagectomy were followed in this study for 3years. Data were collected on patients' sociodemographics, cancer characteristics, adjuvant therapy, general QOL and EC-specific QOL (before esophagectomy and 6months afterward), cancer recurrence, and death. Patients' independent risk factors for 3-year survival were investigated by multivariate Cox regression analysis. Of the 67 participants with EC, 26 had late mortality, with a median survival for the whole cohort of 38.2months (95% CI 31.97-44.35). Independent predictors of early death were early cancer recurrence (within 6months after surgery), poor cognitive function (95% CI 1.020-1.041), and worse dyspnea (95% CI 1.007-1.034). The most predictive factor for early death in EC patients after esophagectomy was cancer recurrence within 6months after surgery. However, QOL measures could be a tool to provide clinical information from patients' perspective suggesting cancer recurrence.