V. Patel2, S. S. Tohme3, K. Bess1, A. Krane1, N. Ahmed1, A. Tsung1, J. L. Steel1 1University Of Pittsburgh School Of Medicine,Department Of Surgery, Division Of Hepatobiliary And Pancreatic Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh,School Of Medicine,Pittsburgh, PA, USA 3University Of Pittsburgh,Department Of Surgery,Pittsburgh, PA, USA
Introduction: There is little evidence to show that health-related quality of life predicts survival across all hepatic malignancies regardless of origin. In addition, there is scant literature on what clinical data can predict a lowered health-related quality of life (HRQL). This study aimed to assess if hepatic resection improved the quality of life of our patient population, if quality of life is a prognostic factor for survival, and to identify predictors of quality of life score.
Methods: The study was a secondary analysis in which patients were enrolled in one of two prospective studies between January 2008 to November 2011. The Functional Assessment of Cancer Therapy-Hepatobiliary, Center for Epidemiologic Studies-Depression, Functional Assessment of Cancer Therapy-Fatigue, and the Brief Pain Inventory were administered. Pearson correlations, ANOVA, Kaplan-Meier and Cox regression analyses were performed to test the aims of the study.
Results:
Of the 128 patients, the mean age was 61 years (S.D.=11.6), 71.9% of patients had stage 4 cancer, 42.6% had hepatocellular carcinoma, and 50.7% had metastatic colorectal carcinoma. Overall HRQL decreased from baseline at the 4-month follow-up but then improved and surpassed baseline at 8 and 12 months.
Using Cox regression, after adjusting for age, diagnosis, Clavien-Dindo Grade, tumor stage, and extrahepatic recurrence, HRQL prior to surgery predicted overall survival (Table 1).
Depressive symptoms (r=-0.666, p<0.001), pain (r=-0.192, p=0.032), and fatigue (r=-0.468, p<0.001) were significantly correlated with HRQL prior to surgery. Significant predictors of HRQL at 8 months follow up included extrahepatic recurrence (p=0.002), depressive symptoms (r=-0.640, p<0.001), pain (r=-0.529, p<0.001), fatigue (r=-0.668, p<0.001), tumor macrovascular invasion (p=0.011), and tumor microvascular invasion (p=0.003) (Table 2).
Conclusion:Surgical resection of hepatic malignancies improved HRQL over the course of one year. HRQL is prognostic of survival in patients with hepatic malignancies undergoing surgery while adjusting for demographics, disease-specific factors, and treatment-related factors. Psychological and disease-specific factors predicted HRQL at baseline and 8 month follow up.
