Quality of Life Is Associated with Survival in Patients with Cirrhosis and Hepatocellular Carcinoma

BACKGROUND: Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL. OBJECTIVE: To characterize QOL among a diverse cohort of cirrhotic patients with HCC and evaluate its association with survival. METHODS: We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30, and QLQ-HCC18, prior to HCC-directed treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan-Meier analysis and compared using log rank test to determine if QOL is associated with survival. RESULTS: 130 treatment-naïve patients were enrolled and completed both surveys. Patients reported fair global QOL (median score 50%), high cognitive and social function (median scores 67%), but poor role function (median score 50%). QOL was associated with both cirrhosis-related (p=0.02) and tumor-related (p=0.02) components of Barcelona Clinic Liver Cancer (BCLC) stage. QOL was associated with survival on univariate analysis (HR 0.37, 95%CI 0.16-0.85) but became non-significant (HR 0.82, 95%CI 0.37-1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95%CI 0.20-0.81), after adjusting for Caucasian race (HR 0.31, 95%CI 0.16-0.59), BCLC stage (HR 1.51, 95%CI 0.21-1.89), and treatment (HR 0.57, 95%CI 0.33-0.97). CONCLUSION: QOL and role function have prognostic significance and are important to assess in cirrhotic patients with HCC.