Baseline quality of life as a prognostic survival tool in patients receiving sunitinib for metastatic renal cell carcinoma
A partir des données d'un essai clinique de phase III incluant des patients atteints d'un carcinome métastatique à cellules rénales et traités par sunitinib, cette étude évalue la valeur pronostique d'un nouvel outil associant un indice estimant la qualité de vie des patients à la durée médiane de survie
Background : In a randomized phase III trial of sunitinib vs interferon-alfa (IFN-
α) in metastatic renal cell carcinoma (mRCC), better baseline quality of life (QoL) was predictive of longer survival. Using this dataset, we have developed a novel prognostic tool that establishes a relationship between baseline QoL scores and median survival time.
Methods
:
Baseline QoL was assessed using the FACT-Kidney Symptom Index-15 item (FKSI-15), its disease-related symptoms (FKSI-DRS) subscale, and the Functional Assessment of Cancer Therapy
–General (FACT-G) scale. Weibull models estimated median progression-free survival (mPFS) and overall survival (mOS) as a function of baseline QoL.
Results : Longer PFS and OS were associated with higher baseline FKSI-15, FKSI-DRS, and FACT-G scores (P<0.05), and baseline FKSI-15 score was the best predictor of survival. For example, for a baseline FKSI-15 score of 60, the predicted mPFS was 67.9 weeks, and predicted mOS was 240.6 weeks. The magnitude of benefit was greater with sunitinib vs IFN-
α for a given baseline QoL score.
Conclusion
:
This novel tool indicates that baseline FKSI-15 scores were linked to mPFS and mOS in a clear and interpretable way. The results support evaluation of patient-reported QoL symptoms at baseline as a prognostic indicator of survival in clinical research and practice.
British Journal of Cancer , résumé, 2011