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Prognostic value of health-related quality of life in patients with metastatic pancreatic adenocarcinoma: a random forest methodology

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Abstract

Purpose

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is currently an important parameter in the choice of treatment strategy for metastatic pancreatic adenocarcinoma (mPA) patients. However, previous research has shown that patients’ self-reported health-related quality of life (HRQOL) scales provided additional prognostic information in homogeneous groups of patients with respect to ECOG-PS. The aim of this study was to identify HRQOL scales with independent prognostic value in mPA and to propose prognostic groups for these patients.

Methods

We analysed data from 98 chemotherapy-naive patients with histologically proven mPA recruited from 2007 to 2011 in the FIRGEM phase II study which aimed to compare the effectiveness of two chemotherapy regimen. HRQOL data were assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. A random survival forest methodology was used to impute missing data and to identify major prognostic factors for overall survival.

Results

Baseline HRQOL assessment was completed by 60 % of patients (59/98). Twelve prognostic variables were identified. The three most important prognostic variables were fatigue, appetite loss, and role functioning, followed by three laboratory variables. The model’s discriminative power assessed by Harrell’s C statistic was 0.65. Fatigue score explained almost all the survival variability.

Conclusion

HRQOL scores have prognostic value for mPA patients with good ECOG-PS. Moreover, the patient’s fatigue, appetite loss, and self-perception of daily activities were more reliable prognostic indicators than clinical and laboratory variables. These HRQOL scores, especially the fatigue symptom, should be urgently included for prognostic assessment of mPA patients (with good ECOG-PS).

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Funding

This study did not receive any direct funding. However, we used data from the FIRGEM phase II trial which was funded by Pfizer and two French associations: AGEO (Association des Gastro-Entérologues Oncologues) and AROLD (Association pour la Recherche en Oncologie Digestive).

Author information

Authors and Affiliations

  1. Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France

    Momar Diouf

  2. Methodology and Quality of Life in Oncology Unit, EA 3181 CHU Besançon and the Qualité de Vie et Cancer Clinical Research Platform, Besançon, France

    Momar Diouf & Franck Bonnetain

  3. Biostatistics Unit, Claudius Régaud Institute, Toulouse, France

    Thomas Filleron

  4. Hepatogastroenterology and Digestive Oncology Department, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France

    Anne-Laure Pointet, Olivier Dubreuil, Bruno Landi, Aziz Zaanan & Julien Taieb

  5. CHU Jean Minjoz, Besançon, France

    Anne-Claire Dupont-Gossard & Francine Fein

  6. Gustave Roussy, Villejuif, France

    David Malka

  7. Hôpital Privé Jean Mermoz, Lyon, France

    Pascal Artru

  8. Centre Georges-François Leclerc, Dijon, France

    Mélanie Gauthier

  9. CHU de Tours–Hôpital Trousseau, Chambray-Les-Tours, France

    Thierry Lecomte

  10. CHU Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France

    Thomas Aparicio

  11. CHU Bicêtre, Le Kremlin-Bicêtre, France

    Anne Thirot-Bidault

  12. CHU Bichat-Claude Bernard, Paris, France

    Céline Lobry

Authors
  1. Momar Diouf
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  2. Thomas Filleron
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  3. Anne-Laure Pointet
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  4. Anne-Claire Dupont-Gossard
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  11. Céline Lobry
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  12. Francine Fein
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  13. Olivier Dubreuil
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  14. Bruno Landi
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  15. Aziz Zaanan
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  16. Julien Taieb
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  17. Franck Bonnetain
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Corresponding authors

Correspondence to Momar Diouf or Julien Taieb.

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Conflict of interest

The authors declared no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Diouf, M., Filleron, T., Pointet, AL. et al. Prognostic value of health-related quality of life in patients with metastatic pancreatic adenocarcinoma: a random forest methodology. Qual Life Res 25, 1713–1723 (2016). https://doi.org/10.1007/s11136-015-1198-x

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  • DOI: https://doi.org/10.1007/s11136-015-1198-x

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