Association between preoperative EQ-5D visual analogue scale score and recurrence-free survival after lung cancer resection
Hideo Ichimura, Keisuke Kobayashi, Masahiko Gosho, Kenji Minagi, Tomoyuki Kawamura, Shuntaro Kawabata, Hisashi Suzuki, Shinsuke Kitazawa, Naohiro Kobayashi, Yukinobu Goto, Yukio SatoAbstract
Objective
To investigate the prognostic impact of preoperative self-reported global health status, assessed with the EQ-5D visual analogue scale (VAS), on recurrence-free survival (RFS) in patients undergoing resection for clinical stage I non-small cell lung cancer (NSCLC).
Methods
This retrospective study included 200 patients from a single-center quality-of-life assessment cohort who underwent complete resection for clinical stage I NSCLC between January 2015 and April 2018. Preoperative QOL was assessed with the EQ-5D-5L. RFS was analyzed with the Kaplan–Meier method and the Cox proportional hazards model. Competing risk analysis was performed to distinguish recurrence from mortality due to other causes.
Results
The median follow-up was 6.0 years and the 5-year RFS rate was 82.2% (42 events). On univariable Cox analysis for RFS, the hazard ratio (HR) per 1-unit decrease in EQ-5D VAS scores was 1.020(95% CI 1.002–1.039). An EQ-5D VAS score ≤55 was also associated with worse RFS (HR 2.762, 95% CI 1.271–6.005; p = 0.010). On competing risk analysis adjusting for Performance Status, and modified Glasgow Prognostic Score, the recurrence risk of lung cancer was significantly higher in the VAS ≤55 group (adjusted HR 3.45, 95% CI 1.09–10.96), whereas mortality from other causes was comparable between the 2 VAS groups.
Conclusions
Lower preoperative EQ-5D VAS scores were associated with poorer recurrence-free survival in patients with clinical stage I NSCLC, driven primarily by increased recurrence rather than by other-cause mortality.