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Preoperative and early postoperative quality of life predict survival in potentially curable patients with esophageal cancer.

van Heijl M, Sprangers MA, de Boer AG, Lagarde SM, Reitsma HB, Busch OR, Tilanus HW, van Lanschot JJ, van Berge Henegouwen MI - Ann. Surg. Oncol. (2009)

Bottom Line: In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival.In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, G4-115, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amc.uva.nl

ABSTRACT

Background: In patients with esophageal cancer, evidence for prognostic significance of preoperative quality of life (QoL) is limited, while the prognostic significance of postoperative QoL has not been investigated at all.

Aim: To determine whether preoperative and postoperative QoL measurements can predict survival independently from clinical and pathological factors, in patients with potentially curable esophageal adenocarcinoma.

Methods: A randomized controlled trial was performed from 1994 to 2000 in two academic medical centres, comparing transthoracic and transhiatal esophagectomy. QoL questionnaires were sent before and 3 months after surgery (Medical Outcome Study Short Form-20 and Rotterdam Symptom Checklist). Uni- and multivariate Cox regression analyses were used to examine firstly the prognostic value of preoperative QoL and several clinical factors, and secondly of postoperative QoL, several clinical factors, and pathological staging.

Results: Out of 220 randomized patients, 199 participated in the QoL-study. In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival. In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).

Conclusion: In the present paper the first large consecutive series of potentially curable esophageal cancer patients is presented in whom prospectively collected QoL data before and after potentially curative surgical resection were used to predict survival. Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.

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Related in: MedlinePlus

a Overall survival of all patients undergoing potentially curative esophagectomy. b Disease-free survival of all patients undergoing potentially curative esophagectomy
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Fig1: a Overall survival of all patients undergoing potentially curative esophagectomy. b Disease-free survival of all patients undergoing potentially curative esophagectomy

Mentions: In all patients, the operation was performed at least 5 years earlier, ensuring a minimal potential follow-up of 5 years (range 5–10.6 years). Overall 5-year survival was 35.5% and 5-year disease-free survival was 32.6% (Fig. 1a, b).Fig. 1


Preoperative and early postoperative quality of life predict survival in potentially curable patients with esophageal cancer.

van Heijl M, Sprangers MA, de Boer AG, Lagarde SM, Reitsma HB, Busch OR, Tilanus HW, van Lanschot JJ, van Berge Henegouwen MI - Ann. Surg. Oncol. (2009)

a Overall survival of all patients undergoing potentially curative esophagectomy. b Disease-free survival of all patients undergoing potentially curative esophagectomy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2805800&req=5

Fig1: a Overall survival of all patients undergoing potentially curative esophagectomy. b Disease-free survival of all patients undergoing potentially curative esophagectomy
Mentions: In all patients, the operation was performed at least 5 years earlier, ensuring a minimal potential follow-up of 5 years (range 5–10.6 years). Overall 5-year survival was 35.5% and 5-year disease-free survival was 32.6% (Fig. 1a, b).Fig. 1

Bottom Line: In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival.In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, G4-115, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amc.uva.nl

ABSTRACT

Background: In patients with esophageal cancer, evidence for prognostic significance of preoperative quality of life (QoL) is limited, while the prognostic significance of postoperative QoL has not been investigated at all.

Aim: To determine whether preoperative and postoperative QoL measurements can predict survival independently from clinical and pathological factors, in patients with potentially curable esophageal adenocarcinoma.

Methods: A randomized controlled trial was performed from 1994 to 2000 in two academic medical centres, comparing transthoracic and transhiatal esophagectomy. QoL questionnaires were sent before and 3 months after surgery (Medical Outcome Study Short Form-20 and Rotterdam Symptom Checklist). Uni- and multivariate Cox regression analyses were used to examine firstly the prognostic value of preoperative QoL and several clinical factors, and secondly of postoperative QoL, several clinical factors, and pathological staging.

Results: Out of 220 randomized patients, 199 participated in the QoL-study. In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival. In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).

Conclusion: In the present paper the first large consecutive series of potentially curable esophageal cancer patients is presented in whom prospectively collected QoL data before and after potentially curative surgical resection were used to predict survival. Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.

Show MeSH
Related in: MedlinePlus