The added value of health-related quality of life as a prognostic indicator of overall survival and progression-free survival in glioma patients: a meta-analysis based on individual patient data from randomised controlled trials

Abstract

OBJECTIVE Prognostic value of health-related quality of life (HRQoL) data may be important to inform patients in clinical practice and to guide clinical decision-making. Our study investigated the added prognostic value of HRQoL for overall survival (OS) and progression-free survival (PFS) in a large heterogeneous sample of glioma patients, besides known prognostic factors. METHODS We included individual baseline data from previously published randomised controlled trials (RCTs) in glioma patients in which HRQoL was assessed through the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BN20 questionnaires. Multivariable Cox regression models (stratified for newly diagnosed versus recurrent disease) were constructed, first with clinical variables (age, sex, tumour type, performance status, allocated treatment and extent of resection) only and subsequently with HRQoL variables added, separately for OS and PFS. The added prognostic value of HRQoL was calculated using C-indices. RESULTS Baseline HRQoL and clinical data from 15 RCTs were included, comprising 5217 patients. In the model including both clinical and HRQoL variables, better cognitive and role functioning and less motor dysfunction were independently associated with longer OS, whereas better role and cognitive functioning, less nausea and vomiting and more appetite loss were independently associated with prolonged PFS. However, C-indices indicated only a small prognostic improvement of the models for OS and PFS when adding HRQoL to the clinical prognostic variables (+1.1% for OS and +.7% for PFS). CONCLUSION Our findings demonstrate that several baseline HRQoL variables are independently prognostic for OS and PFS, yet the added value of HRQoL to the known clinical prognostic variables was small.

Studies for Better Treatment of Patients with Glioma

“…Glioma is the most frequent malignant primary brain tumor and accounts for approximately 50% of all primary intracranial tumors, the other half mainly consisting of meningioma 1 . Gliomas belong to the most malignant tumors.…”

“…Gliomas belong to the most malignant tumors. They comprise approximately 1% of all cancers diagnosed in Sweden with over 500 persons being diagnosed with glioma annually 1,2 . It is a disease that can cause a variety of neurological symptoms, mainly reflecting the function of the site of the tumor in the brain.…”

“…The most important clinical prognostic factors for glioma patients are diagnosis, age, performance status and type of surgery 1,40,45 . Gender is usually referred to as being prognostic, as women are often reported to have better survival 46 .…”

“…Gender is usually referred to as being prognostic, as women are often reported to have better survival 46 . An analysis regarding gender differences in the Swedish National Quality Registry (SNQR), showed some differences for high grade glioma, but median survival was equal between men and women (315 versus (vs) 326 days, women vs men), even though for mean survival there was an advantage for women (742 vs 628 days, women vs men)(Poster P01.151 EANO (European Association of Neuro-Oncology) 2018) 1 . IDH mutations and especially 1p/19q codeletions confer a better prognosis as compared to IDH wildtype tumors, as mentioned previously 34 .…”

“…The aims of the SNQR are to contribute to better care for brain tumor patients, and to clinical studies. The SNQR also provides a foundation for work with quality assurance, and for compiling national brain tumor statistics 1,27 The registry was launched in 1999, covering all patients with the primary intracranial tumors glioma and meningioma, from the six regions of Sweden. Coverage of the reports has varied in the different regions, but has generally improved over time.…”