St George Hospital, Sydney, Australia
Felicia Roncolato , Emma Gibbs , Chee Lee , Lucy Claire Davies , Val Gebski , Michael Friedlander , Felix Hilpert , Lari B. Wenzel , Martin R. Stockler , Madeleine Trudy King , Eric Pujade-Lauraine
Background: Women with PROC are a heterogeneous group with a median overall survival of 12 months. We hypothesised that QOL measures would be significant prognostic factors in PROC and improve predictions of survival based on clinical factors. Methods: Data from 333 participants in AURELIA, randomised phase 3 trial of chemotherapy +/- bevacizumab, was used to identify domains of QOL, measured at baseline with the EORTC QLQ-C30 & OV28, that were significantly associated with OS in Cox regression analyses. Cut-points were determined to categorise patients as low, medium and high risk groups. Multivariable analysis for categorised QOL domains significantly associated with OS was performed adjusting for established clinical prognostic factors. Cut-points were validated in an independent dataset, CARTAXHY, a randomised trial comparing different chemotherapies in PROC. Results: In AURELIA, physical functioning (PF), role, emotional, social, global health, and abdominal/gastrointestinal symptoms (AGS) scores were significantly associated with OS in univariable analyses. PF (P < 0.001) and AGS (P < 0.001) scores remained significant in multivariable models. When categorized into high (PF score < 67), medium (67-92), and low ( > 92) risks, mOS were 11.2, 14.7 and 19.3 months respectively (P < 0.001). These categories were applied in the CARTAXHY population (N = 136), and mOS were 7.9, 16.2 and 23.9 months (P < 0.001) respectively. For high (AGS score > 44), medium (13-44), and low ( < 13) risks, mOS were 11.9, 14.3, and 20.0 months in AURELIA (P < 0.001); and 10.5, 19.6, and 24.1 months in CARTAXHY (P = 0.001). PF (P = 0.048) and AGS (P = 0.011) remained independently significant prognostic factors after adjusting for performance status, ascites, CA125, platinum-free interval, primary platinum resistance, and size of measurable lesions. Conclusions: Self-ratings of physical functioning and abdominal/gastrointestinal symptom scores improved predictions of overall survival based on traditional clinical factors in PROC. This additional prognostic information could improve stratification in clinical trials, patient-doctor-communication about prognosis, and clinical decision-making. Clinical trial information: NCT00976911
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