Quality of Life Supersedes the Classic Prognosticators for Long-Term Survival in Locally Advanced Non-Small-Cell Lung Cancer: An Analysis of RTOG 9801
Quality of Life Supersedes the Classic Prognosticators for Long-Term Survival in Locally Advanced Non-Small-Cell Lung Cancer: An Analysis of RTOG 9801
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DOI：
10.1200/jco.2009.23.7420
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发表时间：
2009-12-01
影响因子：
45.3
通讯作者：
Bruner, Deborah Watkins
中科院分区：
文献类型：
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作者：
Movsas, Benjamin;Moughan, Jennifer;Bruner, Deborah Watkins
目的探讨局部晚期非小细胞肺癌（NSCLC）患者在接受放射治疗肿瘤学组RTOG-9801治疗后，生活质量（QOL）作为总生存期（OS）的预后因素的附加值。患者与方法243例II/IIAB期NSCLC患者接受紫杉醇和卡铂（PC）诱导治疗，然后同时接受每周一次PC和超分割放射治疗（至69.6戈伊）。在放化疗期间，患者被随机分配到氨磷汀（AM）或无AM。将以下治疗前因素作为OS的预后因素进行分析：Karnofsky体能状态、分期、性别、年龄、人种、婚姻状况、组织学、肿瘤位置、血红蛋白、烟草使用、治疗组（AM vs无AM）和QOL评分（欧洲癌症研究与治疗组织生活质量问卷C30 [QLQ-C30]和肺癌13 [LC-13]）。一个多变量（MVA）考克斯比例风险模型进行了向后选择process.ResultsOf 239分析患者，91%的基线全球生活质量评分。存活患者的中位随访时间为59个月，所有患者为17个月。两个治疗组的中位基线QLQ-C30总体QOL评分为66.7。无论将总体QOL评分作为二分变量（基于中位数评分）还是连续变量处理，所有其他变量均不在OS的MVA范围内。总体QOL评分低于66.7的患者的死亡率比评分≥ 66.7的患者高约70%（P = 0.004）。基线总体QOL评分高10分对应于死亡风险降低约10%（P = 0.004）。OS的其他独立QOL预测因子是QLQ-C30身体功能（P = 0.011）和LC-13呼吸困难评分（P = 0.012）。
PurposeTo determine the added value of quality of life (QOL) as a prognostic factor for overall survival ( OS) in patients with locally advanced non-small-cell lung cancer (NSCLC) treated on Radiation Therapy Oncology Group RTOG-9801.Patients and MethodsTwo hundred forty-three patients with stage II/IIIAB NSCLC received induction paclitaxel and carboplatin (PC) and then concurrent weekly PC and hyperfractionated radiation ( to 69.6 Gy). Patients were randomly assigned to amifostine (AM) or no AM during chemoradiotherapy. The following pretreatment factors were analyzed as prognostic factors for OS: Karnofsky performance status, stage, sex, age, race, marital status, histology, tumor location, hemoglobin, tobacco use, treatment arm (AM v no AM) and QOL scores (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 [QLQ-C30] and Lung Cancer 13 [LC-13]). A multivariate (MVA) Cox proportional hazards model was performed using a backwards selection process.ResultsOf the 239 analyzable patients, 91% had a baseline global QOL score. Median follow-up time was 59 months for patients still alive and 17 months for all patients. Median baseline QLQ-C30 global QOL score was 66.7 on both treatment arms. Whether the global QOL score was treated as a dichotomized variable ( based on the median score) or a continuous variable, all other variables fell out of the MVA for OS. Patients with a global QOL score less than 66.7 had an approximately 70% higher rate of death than patients with scores >= 66.7 (P = .004). A 10-point higher baseline global QOL score corresponded to a decrease in the hazard of death by approximately 10% (P = .004). The other independent QOL predictors for OS were the QLQ-C30 physical functioning (P = .011) and LC-13 dyspnea scores (P = .012).ConclusionIn this analysis, baseline global QOL score replaced known prognostic factors as the sole predictor of long-term OS for patients with locally advanced NSCLC.