Purpose: Accumulating reports suggest that quality of life (QOL) may predict survival in cancer patients. In this study, we longitudinally investigated whether the QOL data assessed before, during, and after treatment are prognostic for the survival of patients with esophageal squamous cell carcinoma treated with primary radiotherapy (RT).
Methods and materials: A total of 110 consecutive new esophageal squamous cell carcinoma patients treated with primary RT were studied. The European Organization for the Research and Treatment of Cancer questionnaire QLQ-C30 (in the Taiwan Chinese version) plus the scales concerning dysphagia and odynophagia were completed before, during, and 2 months after RT. Cox proportional hazards models were used to analyze the impact of clinical and QOL variables on survival.
Results: A clinical model that included clinical and sociodemographic variables to predict survival using multivariate analysis revealed weight loss, American Joint Committee on Cancer stage, and radiation dose to be statistically significant survival predictors. For QOL scores before RT, physical functioning was the most significant survival predictor. The 2-year survival rate was 30% for patients with a physical functioning score of > or =80.0 compared with a survival rate of 20% for those with a score of <80.0. The QOL scores during RT did not significantly correlate with survival. Of the QOL scores 2 months after RT, the dysphagia symptom scale was the most significant survival predictor. Improvement in dysphagia was observed in 43.0% of patients during RT and in 48.4% of patients 2 months after RT. A dysphagia-free status was found in 35.5% of patients 2 months after RT. The 2-year survival rate was 54.5% for patients without dysphagia 2 months after RT compared with 14.3% for those with dysphagia (p <0.001).
Conclusion: The data provide evidence to support the correlation of patient-reported QOL scores with survival. Pretreatment physical functioning might be a surrogate marker of an unrecognized biologic prognostic factor. The poor survival outcome for patients with persistent dysphagia after treatment implies that local control remains the main issue to overcome in treating esophageal cancer with RT.