AbstractObjective:Several studies have shown baseline health-related quality of life (HRQOL) to be a valuable prognostic indicator of survival outcomes for various cancer entities in the metastatic setting. To date, there is no evidence regarding the prognostic value of baseline HRQOL for patients undergoing radical prostatectomy (RP) due to localized prostate cancer (PC).
1029 patients with high-risk PC according to NCCN risk stratification and prospectively assessed baseline HRQOL prior to RP were identified. Patients were stratified by global health status (GHS) domain of the QLQ-C30 questionnaire. Oncologic endpoints were biochemical recurrence-free survival (BRFS) and metastasis-free survival (MFS). Multivariable Cox regression models were performed to assess prognostic significance of baseline GHS on survival outcomes. Harrell's discrimination C-index was applied to calculate the predictive accuracy of the model and previous described risk stratification models. Decision curve analysis (DCA) was applied to test the clinical net benefit associated with adding GHS to our multivariable model (p<0.05).
Median follow-up was 43 months. In multivariable analysis, GHS was confirmed as an independent predictor for increased BRFS (HR 0.97, 95%CI 0.96-0.99; p=0.001) and MFS (HR 0.96, 95%CI 0.93-0.99; p=0.013), indicating a relative risk reduction of 2.9% for BRFS and 3.7% for MFS per 1-point increase of baseline GHS. Adding baseline HRQOL to our model and to the CAPRA and NCCN score improved discrimination in predicting BRFS and MFS of the respective models. DCA revealed a net benefit over all threshold probabilities.
Our findings highlight baseline HRQOL to be a valuable and robust prognostic factor for patients with localized high-risk PC prior RP. Baseline HRQOL increased prognostic accuracy of BRFS and MFS.
The Journal of urology. 2022 Jul 05 [Epub ahead of print]
Thilo Westhofen, Alexander Buchner, Veeru Kasivisvanathan, Simon Lennartz, Boris Schlenker, Armin Becker, Christian G Stief, Alexander Kretschmer
Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany., Division of Surgery and Interventional Science, University College London, UK., Institute for Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.