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Quality of life supersedes the classic prognosticators for long-term survival in locally advanced non-small-cell lung cancer: An analysis of RTOG 9801
Journal of Clinical Oncology, 10/29/09

Movsas B et al. –The goal of this study was to 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. In this analysis, baseline global QOL score replaced known prognostic factors as the sole predictor of long-term OS for patients with locally advanced NSCLC.

Methods

243 patients with stage II/IIIAB NSCLC received induction paclitaxel and carboplatin (PC) and then concurrent weekly PC and hyperfractionated radiation
Patients randomly assigned to amifostine (AM) or no AM during chemoradiotherapy
Following pretreatment factors 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 )and Lung Cancer 13
Multivariate (MVA) Cox proportional hazards model performed using backwards selection process

Results

Of 239 analyzable patients, 91% had baseline global QOL score
Median follow-up time 59 months for patients still alive and 17 months for all patients
Median baseline QLQ-C30 global QOL score 66.7 on both treatment arms
Whether global QOL score treated as dichotomized variable (based on the median score) or a continuous variable
All other variables fell out of MVA for OS
Patients with global QOL score less than 66.7 had approximately 70% higher rate of death than patients with scores ≥ 66.7
10-point higher baseline global QOL score corresponded to decrease in hazard of death by approximately 10%
Other independent QOL predictors for OS were QLQ-C30 physical functioning and LC-13 dyspnea scores

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