Baseline HRQOL predicts survival in high-risk prostate cancer after radical prostatectomy

Baseline health-related quality of life (HRQOL) among patients with localized high-risk prostate cancer prior to radical prostatectomy is an important and a strong predictor of survival, suggests a study.

“Baseline HRQOL increased prognostic accuracy of biochemical recurrence-free survival and metastasis-free survival,” the authors said.

The study included 1,029 patients with high-risk prostate cancer, based on the National Comprehensive Cancer Network risk stratification, and prospectively assessed baseline HRQOL prior to radical prostatectomy. Participants were stratified using the global health status domain of the QLQ-C30 questionnaire. Biochemical recurrence- and metastasis-free survivals were the oncologic endpoints.

The authors used multivariable Cox regression models to examine the prognostic significance of baseline global health status on survival outcomes. They also applied Harrell’s discrimination C-index to estimate the predictive accuracy of the model and previously described risk stratification models. Finally, they carried out a decision curve analysis to test the clinical net benefit of adding global health status to the multivariable model (p<0.05).

Over a median follow-up of 43 months, multivariable analysis confirmed that global health status was independently associated with greater biochemical recurrence-free survival (hazard ratio [HR], 0.97, 95 percent confidence interval [CI], 0.96‒0.99; p=0.001) and metastasis-free survival (HR, 0.96, 95 percent CI, 0.93‒0.99; p=0.013).

This finding suggested a relative risk reduction of 2.9 percent for biochemical recurrence-free survival and 3.7 percent for metastasis-free survival per 1-point increase in baseline global health status.

The addition of baseline HRQOL to the multivariable model and to the Cancer of the Prostate Risk Assessment and National Comprehensive Cancer Network score enhanced discrimination in predicting biochemical recurrence- and metastasis-free survivals of the respective models. In addition, decision curve analysis bared a net benefit over all threshold probabilities.