In this study, doctors from England evaluated baseline prognostic factors in patients with locally advanced or metastatic esophago-gastric cancer. They also assessed whether pretreatment quality of life predicted survival.
The team studied 1080 patients were enrolled in 3 randomized, controlled trials which assessed fluorouracil-based combination chemotherapy, between 1992 and 2001.
All patients completed the European Organization for Research and Treatment of Cancer core quality of life questionnaire before randomization.
The team found that of the 1080 patients, 91% died.
They identified 4 independent poor prognostic factors using multivariate analysis. These were performance status ≤2 (hazard ratio 1.58), liver metastases (HR 1.41), peritoneal metastases (HR 1.33), and alkaline phosphatase ≤100 U/L (HR, 1.41).
The team also constructed a prognostic index which divided patients into good (no risk factor), moderate (1 or 2 risk factors) or poor (3 or 4 risk factors) risk groups.
The team found that 1-year survival for good, moderate, and poor risk groups was 49%, 26%, and 11%, respectively.
When compared with the good risk group, the moderate risk group had nearly twice the risk of death, and the poor risk group had 3.5-fold increased risk of death.
The doctors also found that pretreatment physical, role functioning, and global quality of life predicted survival.
Dr Ian Chau and colleagues concluded, "Four poor prognostic factors were identified and a simple prognostic index was devised".
"Information from this analysis can be used to aid clinical decision-making, help individual patient risk stratification, and serve as benchmark for the planning for future phase III trials".