Health-related quality of life upon diagnosis has been found to be an important predictive factor of survival outcomes for a variety of cancer entities in the metastatic situation by several studies. Health-related quality of life at baseline has not been shown to have predictive significance for patients receiving radical prostatectomy for localized prostate cancer.
Prior to undergoing radical prostatectomy, 1,029 men were recognized as having high-risk prostate cancer based on the National Comprehensive Cancer Network® risk assessment. Patients were divided into groups based on how they scored on the QLQ-question C30’s on their general health. Biochemical recurrence-free survival and progression-free survival were used as oncologic outcomes. The predictive impact of baseline global health status on survival outcomes was evaluated using multivariate Cox regression models. Researchers compared the model’s predictive accuracy to previously described risk stratification models using Harrell’s discrimination C-index. The net clinical advantage of including global health status in a multivariate model was evaluated using a decision curve analysis (P<.05).
There was a median follow-up of 43 months. Increased biochemical recurrence-free survival (HR.97, 95% CI.96-.99; P =.001) and metastasis-free survival (HR.96, 95% CI.93-.99; P =.013) were also independently predicted by higher global health status in multivariable analysis. Biochemical recurrence-free survival was reduced by 2.9% for every 1-point increase in global health status at baseline, and metastasis-free survival was reduced by 3.7% for every 1-point increase in global health status at baseline, according to multivariable analysis. Their model and the Cancer of the Prostate Risk Assessment and National Comprehensive Cancer Network score both improved their discrimination in predicting biochemical recurrence-free survival and metastasis-free survival after including health-related quality of life as a baseline variable. The examination of decision curves showed a positive outcome regardless of the threshold probability used.
In conclusion, these results suggest that health-related quality of life at baseline is a valuable and robust predictive factor for patients with localized high-risk prostate cancer before radical prostatectomy. In addition, the accuracy of prognosticating biochemical recurrence-free and metastasis-free survival was improved using health-related quality of life at baseline.
Source: auajournals.org/doi/full/10.1097/JU.0000000000002826
