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A Prospective Evaluation of the Reliability and Utility of Quality of Life Measures in Patients With Hepatocellular Carcinoma

Kim, Gi-Ae MD, PhD*; Kim, Ha Il MD; Chang, Seheon MD; An, Jihyun MD, PhD; Lee, Danbi MD, PhD; Lee, Han Chu MD, PhD; Han, Seungbong PhD§; Shim, Ju Hyun MD, PhD

American Journal of Clinical Oncology: July 2019 - Volume 42 - Issue 7 - p 555–563
doi: 10.1097/COC.0000000000000555
Original Articles: Gastrointestinal

Objectives: Little is known about how quality of life (QOL) can assist clinical decision-making for patients with hepatocellular carcinoma (HCC). This study aimed to investigate the reliability and validity of QOL as well as its prognostic value and utility.

Materials and Methods: A prospective cohort of 300 HCC patients at various stages was recruited from 2015 to 2017 in Korea. The subjects answered the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30) and QLQ-HCC18 and the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Prognostic nomograms including the QOL scales were developed. The prediction performance of the Barcelona Clinic Liver Cancer (BCLC) and the American Joint Committee on Cancer (AJCC) staging systems when they were incorporated with QOL was investigated.

Results: The EORTC QLQ-C30 and QLQ-HCC18 subscales showed higher reliability than FACT-Hep subscales. With regard to the validity, both questionnaires discriminated the patients by stages, treatment modalities, and performance status effectively. Multivariable analysis revealed that EORTC role functioning and EORTC appetite loss subscales were statistically associated with overall survival and disease progression. The developed nomograms accurately estimated the 1-year overall survival and disease progression–free rates. Incorporating the EORTC role functioning subscale or Hepatobiliary Cancer Subscale of FACT-Hep with the BCLC and AJCC systems improved the prognostic classification. Incorporating QOL into the AJCC system showed better predictive accuracy than incorporating performance status into it did.

Conclusions: The findings suggest that QOL data can serve as a reliable predictive factor and assist prognostic calculation for HCC patients.

*Department of Internal Medicine, Kyung Hee University School of Medicine

Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul

Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri

§Department of Applied Statistics, Gachon University, Seongnam-si, Gyeonggi-do, Republic of Korea

S.H. and J.H.S. are co-corresponding authors.

Supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (NRF-2017R1E1A1A01074298 and NRF-2017R1C1B1006717).

G.-A.K., J.H.S., and S.H.: responsible for the concept and design of the study, the acquisition, analysis, and interpretation of the data, and the drafting of the manuscript. S.H.: performed the statistical analyses. H.I.K., S.C., J.A., D.L., and H.C.L.: helped with the acquisition of the data and critically revised the manuscript for important intellectual content.

The authors declare no conflicts of interest.

Reprints: Ju Hyun Shim, MD, PhD, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. E-mail:

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