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JU INSIGHT: The Added Value of Baseline Health-related Quality of Life in Predicting Survival in High-risk Prostate Cancer Patients Following Radical Prostatectomy

By: Thilo Westhofen, MD; Alexander Buchner, MD; Veeru Kasivisvanathan, MBBS, BSc, FRCS, MSc, PGCert, PhD; Simon Lennartz, MD; Boris Schlenker, MD; Armin Becker, MD; Christian G. Stief, MD, PhD; Alexander Kretschmer, MD, FEBU | Posted on: 01 Nov 2022

Westhofen T, Buchner A, Kasivisvanathan V, et al. The added value of baseline health-related quality of life in predicting survival in high-risk prostate cancer patients following radical prostatectomy. J Urol. 2022;208(5):1056-1064.

Study Need and Importance

The prognostic value of preoperative health-related quality of life (HRQOL) in predicting survival outcomes following radical prostatectomy remains unclear.

Figure. Decision curve analysis testing the clinical net benefit of adding global health status (GHS) to our multivariable model in comparison with the multivariable model without lobal health status, Cancer of the Prostate Risk Assessment (CAPRA), and National Comprehensive Cancer Network (NCCN) risk classification systems in predicting the risk of biochemical recurrence at 43 months.

What We Found

We analyzed a contemporary cohort of 1,029 patients with high-risk or highest-risk localized prostate cancer and prospectively assessed preoperative baseline HRQOL. Patients were stratified by global health status (GHS) domain of the QLQ-C30 questionnaire. Baseline GHS was confirmed as an independent predictor for increased biochemical recurrence-free survival (BRFS; HR 0.97 per 1-point increase of baseline GHS, 95%CI 0.96-0.99; P < .01) and metastasis-free survival (MFS; HR 0.96, 95%CI 0.93-0.99; P = .01) in multivariate analysis. Discrimination in predicting BRFS and MFS, assessed by Harrell’s discrimination C-index, was improved when adding baseline HRQOL to our multivariate model, as well as when adding to established Cancer of the Prostate Risk Assessment (CAPRA) and National Comprehensive Cancer Network (NCCN) models. The clinical net benefit associated with adding GHS to our multivariable model was confirmed by decision curve analysis (see Figure).

Limitations

The limitations are mainly due to the retrospective nature of the study. Therefore, the study might not be adjusted for some known and other unknown confounders. Furthermore, the study lacks overall survival data.

Interpretation for Patient Care

In the current study, we found baseline HRQOL to independently predict BRFS and MFS for patients, who underwent radical prostatectomy for high-risk localized prostate cancer. We found the addition of baseline HRQOL scores to improve stratification by established multivariable risk models, namely CAPRA and NCCN.

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