Could baseline health-related quality of life (QoL) predict overall survival in metastatic colorectal cancer? The result
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RESEARCH
Open Access
Could baseline health-related quality of life (QoL) predict overall survival in metastatic colorectal cancer? The results of the GERCOR OPTIMOX 1 study Momar Diouf1,2*, Benoist Chibaudel3, Thomas Filleron5, Christophe Tournigand6, Marine Hug de Larauze4, Marie-Line Garcia-Larnicol3, Sarah Dumont3, Christophe Louvet7, Nathalie Perez-Staub3, Alexandra Hadengue4, Aimery de Gramont3 and Franck Bonnetain2,4
Abstract Background: Health-related quality of life (QoL) has prognostic value in many cancers. A recent study found that the performance of prognostic systems for metastatic colorectal cancer (mCRC) were improvable. We evaluated the independent prognostic value of QoL for overall survival (OS) and its ability to improve two prognostic systems’performance (Köhne and GERCOR models) for patients with mCRC. Methods: The EQ-5D questionnaire was self-completed before randomization in the OPTIMOX1, a phase III trial comparing two strategies of FOLFOX chemotherapy which included 620 previously untreated mCRC patients recruited from January 2000 to June 2002 from 56 institutions in five countries. The improvement in models’ performance (after addition of QoL) was studied with Harrell’s C-index and the net reclassification improvement. Results: Of the 620 patients, 249 (40%) completed QoL datasets. The Köhne model could be improved by LDH, mobility and pain/discomfort; the C-index rose from 0.54 to 0.67. The associated NRI for 12-month death was 0.23 [0.05; 0.46]. Mobility and pain/discomfort could be added to the GERCOR model: the C-index varied from 0.63 to 0.68. The NRI for 12 months death was 0.35 [0.12; 0.44]. Conclusions: Mobility and pain dimensions of EQ5D are independent prognostic factors and could be useful for staging and treatment assignment of mCRC patients. Presented at the 2011 ASCO Annual Meeting (#3632).
Background Colorectal cancer (CRC) is the third most diagnosed cancer in men and the second most diagnosed in women, with over 1.2 million new cases and 608 700 deaths worldwide in 2008 [1]. About up to half (20% to 50%) of CRC patients will develop metastases during the course of their disease [2] and approximately 35% are diagnosed with synchronous metastases [2,3]. Standard treatments for metastatic CRC (mCRC) are based on chemotherapy. * Correspondence: [email protected] 1 Direction de la Recherche Clinique et de l’Innovation, Centre Hospitalier Universitaire Amiens, Nord, 1, Place Victor Pauchet, F-80054, Amiens, Cedex, France 2 Methodology and quality of life in oncology Unit, EA 3181 CHU Besançon and the Qualité de Vie et Cancer clinical research platform, Dijon, France Full list of author information is available at the end of the article
As is the case for many cancers, CRC staging is essential for optimal patient management. Accurate prognostication facilitates both therapeutic decisions and stratification in randomized clinical trials of cancer treatments. In CRC, the well-known TNM staging system is predominantly used [4]. In mCRC, two validated prognostic classi
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