246例非小细胞肺癌的预后影响因素分析

目的:分析246例非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的预后影响因素.方法:回顾性分析2010年1月至2014年12月246例非小细胞肺癌患者临床资料,采用Kaplan-Meier法进行生存分析,Log-rank检验和Cox模型预后影响因素行单因素和多因素分析.结果:全组患者中位生存时间为37.44个月.1年、3年、5年总生存率分别为72％、46％、26％.单因素分析显示,男性、年龄＞75岁、晚期、有吸烟史、有肝转移、无手术史非小细胞肺癌患者的中位生存期明显缩短(P＜0.05或P＜0.01).多因素分析显示,性别、疾病分期、是否吸烟和是否手术是影响非小细胞肺癌预后的独立因素(P ＜0.05或P＜0.01).结论:性别、疾病分期、是否吸烟和是否手术是非小细胞肺癌的独立预后因素.     

Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer

Background:

The inflammation-based Glasgow prognostic score (GPS) has been shown to be a prognostic factor for a variety of tumours. This study investigates the significance of the modified GPS (mGPS) for the prognosis of patients with gastric cancer.

Methods:

The mGPS (0=C-reactive protein (CRP)⩽10 mg l⁻¹, 1=CRP>10 mg l⁻¹ and 2=CRP>10 mg l⁻¹ and albumin<35 g l⁻¹) was calculated on the basis of preoperative data for 1710 patients with gastric cancer who underwent surgery between January 2000 and December 2007. Patients were given an mGPS of 0, 1 or 2. The prognostic significance was analysed by univariate and multivariate analyses.

Results:

Increased mGPS was associated with male patient, old age, low body mass index, increased white cell count and neutrophils, elevated carcinoembryonic antigen and CA19-9 and advanced tumour stage. Kaplan–Meier analysis and log-rank test revealed that a higher mGPS predicted a higher risk of postoperative mortality in both relative early-stage (stage I; P<0.001) and advanced-stage cancer (stage II, III and IV; P<0.001). Multivariate analysis demonstrated the mGPS to be a risk factor for postoperative mortality (odds ratio 1.845; 95% confidence interval 1.184–2.875; P=0.007).

Conclusion:

The preoperative mGPS is a simple and useful prognostic factor for postoperative survival in patients with gastric cancer.     

A radiomics prognostic scoring system for predicting progression-free survival in patients with stage IV non-small cell lung cancer treated with platinum-based chemotherapy

ObjectiveTo develop and validate a radiomics prognostic scoring system (RPSS) for prediction of progression-free survival (PFS) in patients with stage IV non-small cell lung cancer (NSCLC) treated with platinum-based chemotherapy.MethodsIn this retrospective study, four independent cohorts of stage IV NSCLC patients treated with platinum-based chemotherapy were included for model construction and validation (Discovery: n=159; Internal validation: n=156; External validation: n=81, Mutation validation: n=64). First, a total of 1,182 three-dimensional radiomics features were extracted from pre-treatment computed tomography (CT) images of each patient. Then, a radiomics signature was constructed using the least absolute shrinkage and selection operator method (LASSO) penalized Cox regression analysis. Finally, an individualized prognostic scoring system incorporating radiomics signature and clinicopathologic risk factors was proposed for PFS prediction.ResultsThe established radiomics signature consisting of 16 features showed good discrimination for classifying patients with high-risk and low-risk progression to chemotherapy in all cohorts (All P<0.05). On the multivariable analysis, independent factors for PFS were radiomics signature, performance status (PS), and N stage, which were all selected into construction of RPSS. The RPSS showed significant prognostic performance for predicting PFS in discovery [C-index: 0.772, 95% confidence interval (95% CI): 0.765−0.779], internal validation (C-index: 0.738, 95% CI: 0.730−0.746), external validation (C-index: 0.750, 95% CI: 0.734−0.765), and mutation validation (C-index: 0.739, 95% CI: 0.720−0.758). Decision curve analysis revealed that RPSS significantly outperformed the clinicopathologic-based model in terms of clinical usefulness (All P<0.05).ConclusionsThis study established a radiomics prognostic scoring system as RPSS that can be conveniently used to achieve individualized prediction of PFS probability for stage IV NSCLC patients treated with platinum-based chemotherapy, which holds promise for guiding personalized pre-therapy of stage IV NSCLC.     

Pretreatment prognostic factors for survival in small-cell lung cancer: A new prognostic index and validation of three known prognostic indices on 341 patients

Aims: a) To identify which pretreatment clinical or blood parameters werepredictive of patient survival in small-cell lung cancer (SCLC) in aretrospective analysis. b) To validate three known prognostic indices: RoyalMarsden Model (index 1), London Group (index 2) and Manchester Score (index3).Patients and methods: From 1981 to 1993, 341 SCLC patients were treatedwith chemotherapy with or without surgery or radiotherapy. Univariate andmultiple regression analyses of survival were performed and the feasibilityof these models was explored, index 1: Karnofsky index, albumin, sodium andalkaline phosphatase; index 2: ECOG performance status (PS), albumin andalanine transaminase; and index 3: lactate dehydrogenase (LDH), diseaseextent, sodium, Karnofsky index, alkaline phosphatase and bicarbonate.Results: Significant prognostic factors for survival after univariate andmultiple regression analysis were: disease extent, PS, creatine kinase,neutrophilia, LDH, hypoalbuminemia, hyperglycemia and bicarbonate. A newprognostic index was performed that included LDH, hypoalbuminemia,neutrophilia, disease extent and PS. It defined three prognostic groups (PG).Median survival and two-year survival for these PG were 12.3, 8 and 3.4 monthsand 16.5%, 2.3% and 0%, respectively. The following PGwere identified after application of the three models proposed: Index 1identified two PG with 0% and 16.6% two-year survival (P <0.001); index 2 detected three PG with 0%, 5% and 15.7%two-year survival (P < 0.001) and index 3 detected three PG with 0%,2.5% and 16.2% two-year survivals, respectively (P < 0.001).Conclusion: A new prognostic index is proposed allowing identification ofthree different PG. The feasibility of three known prognostic models wasvalidated and demonstrated. Variables other than disease extent or PS (albuminor LDH) should be taken into account in designing future clinical trials.     

术前中性粒细胞/淋巴细胞比值和Glasgow评分对非小细胞肺癌预后的影响

目的:探讨术前外周血中性粒细胞/淋巴细胞比值(NLR)、Glasgow评分(GPS)对肺癌患者预后的影响.方法:分析82例肺癌病人的临床资料,术前外周血NLR以中位数2.98为截取值分为低NLR组和高NLR组,GPS根据C-反应蛋白、白蛋白水平分为0、1、2分组,分析二者与临床病理特征的关系.采用单因素和多因素分析患者NLR、GPS评分与总生存时间的关系.结果:低NLR组与高NLR组中位生存时间(OS)分别为25.5、15.1个月,差异有统计学意义(P<0.05).Glasgow 0、1、2分组中位生存时间(OS)分别为27.1、16.7、11.6个月,差异有统计学意义(P<0.05).多因素分析显示NLR和GPS均是影响肺癌预后的独立危险因素(RR:2.864,95%CI:1.287~6.370,P=0.010;RR:1.838,95%CI:1.036~3.259,P=0.037).结论:术前NLR和GPS均是影响肺癌预后的独立危险因素,NLR和GPS升高提示预后不良.     

Circulating interleukin‐6 level is a prognostic marker for survival in advanced nonsmall cell lung cancer patients treated with chemotherapy

Lung cancer is the leading cause of cancer death worldwide as well as in Taiwan. Interleukin‐6 (IL‐6) is a multifunctional cytokine and has been implicated in tumor progression. This study recruited 245 patients with advanced (Stage 3B/4) nonsmall cell lung cancer (NSCLC) that had received chemotherapy, to evaluate associations between IL‐6 and lung cancer‐specific survival. Among these subjects, 112 gave blood samples before and 133 after the start of chemotherapy. Plasma IL‐6 was measured using an enzyme linked‐immunosorbent assay. The 33rd and 66th percentiles of IL‐6 concentrations were 2.01 and 25.16 for the 245 patients and were defined as the cutoff points for dividing the patients into low, intermediate and high groups. Kaplan‐Meier and Cox proportional‐hazard models were used to evaluate the relationship between the IL‐6 level and survival time. Results after adjusting for age, sex, smoking history, histologic type and stage of lung cancer revealed a significant relationship. For all patients, the hazard ratio with high IL‐6 levels for lung cancer‐specific survival was 2.10 [95% confidence interval (CI) = 1.49 ? 2.96] compared with low IL‐6 levels. The hazard ratio for patients who were recruited before and after the start of chemotherapy was1.25 (95% CI = 0.73 ? 2.13) and 3.66 (95% CI = 2.18 ? 6.15), respectively. Patients with high circulating IL‐6 also responded poorly to chemotherapy. Therefore, a high level of circulating IL‐6 was associated with an inferior response and survival outcome in NSCLC patients treated with chemotherapy.     

Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer

Prediction of outcome in patients with metastatic breast cancer remains problematical. The present study evaluated the value of an inflammation-based score (Glasgow Prognostic Score, GPS) in patients with metastatic breast cancer. The GPS was constructed as follows: patients with both an elevated C-reactive protein (>10 mg l(-1)) and hypoalbuminaemia (<35 g l(-1)) were allocated a score of 2. Patients in whom only one or none of these biochemical abnormalities was present were allocated a score of 1 or 0, respectively. In total, 96 patients were studied. During follow-up 51 patients died of their cancer. On multivariate analysis of the GPS and treatment received, only the GPS (HR 2.26, 95% CI 1.45-3.52, P<0.001) remained significantly associated with cancer-specific survival. The presence of a systemic inflammatory response (the GPS) appears to be a useful indicator of poor outcome independent of treatment in patients with metastatic breast cancer.     

The systemic inflammatory response,weight loss,performance status and survival in patients with inoperable non-small cell lung cancer

The relationship between the magnitude of systemic inflammatory response and the nutritional/functional parameters in patients with inoperable non-small cell lung cancer were studied. The extent of weight loss, albumin, C-reactive protein, performance status and quality of life was measured in 106 patients with inoperable non-small cell lung cancer (stages III and IV). Survival analysis was performed using the Cox proportional hazard model. The majority of patients were male and almost 80% had elevated circulating C-reactive protein concentrations (>10 mg x l(-1)). On multivariate analysis, age (P=0.012), tumour type (0.002), weight loss (P=0.056), C-reactive protein (P=0.047), Karnofsky performance status (P=0.002) and fatigue (P=0.046) were independent predictors of survival. The patients were grouped according to the magnitude of the C-reactive protein concentrations (< or =10, 11-100 and >100 mg x l(-1)). An increase in the magnitude of the systemic inflammatory response was associated with increased weight loss (P=0.004), reduced albumin concentrations (P=0.001), reduced performance status (P=0.060), increased fatigue (P=0.011) and reduced survival (HR 1.936 95%CI 1.414-2.650, P<0.001). These results indicate that the majority of patients with inoperable non-small cell lung cancer have evidence of a systemic inflammatory response. Furthermore, an increase in the magnitude of the systemic inflammatory response resulted in greater weight loss, poorer performance status, more fatigue and poorer survival.     

Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer

There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients with advanced cancer. The aim of the present study was to examine whether an inflammation-based prognostic score (Glasgow Prognostic score, GPS) was associated with survival, in patients with inoperable gastro-oesophageal cancer. Patients diagnosed with inoperable gastro-oesophageal carcinoma and who had measurement of albumin and C-reactive protein concentrations, at the time of diagnosis, were studied (n=258). Clinical information was obtained from a gastro-oesophageal cancer database and analysis of the case notes. Patients with both an elevated C-reactive protein (>10 mg l(-1)) and hypoalbuminaemia (<35 g l(-1)) were allocated a GPS score of 2. Patients in whom only one of these biochemical abnormalities was present were allocated a GPS score of 1, and patients with a normal C-reactive protein and albumin were allocated a score of 0. On multivariate survival analysis, age (hazard ratio (HR) 1.22, 95% CI 1.02-1.46, P<0.05), stage (HR 1.55, 95% CI 1.30-1.83, P<0.001), the GPS (HR 1.51, 95% CI 1.22-1.86, P<0.001) and treatment (HR 2.53, 95% CI 1.80-3.56, P<0.001) were significant independent predictors of cancer survival. A 12-month cancer-specific survival in patients with stage I/II disease receiving active treatment was 67 and 60% for a GPS of 0 and 1, respectively. For stage III/IV disease, 12 months cancer-specific survival was 57, 25 and 12% for a GPS of 0, 1 and 2, respectively. In the present study, the GPS predicted cancer-specific survival, independent of stage and treatment received, in patients with inoperable gastro-oesophageal cancer. Moreover, the GPS may be used in combination with conventional staging techniques to improve the prediction of survival in patients with inoperable gastro-oesophageal cancer.     

可手术非小细胞肺癌多学科治疗对预后因素的影响

背景与目的：肺癌为当前最常见的恶性肿瘤之一，其中非小细胞肺癌（NSCLC）占绝大多数，而且大部分在诊断时已属晚期，对Ⅲ期估计不能全部切除的NSCLC，通过新辅助化疗可以使原发肿瘤缩小，提高手术切除率，消灭微小转移，延长NSCLC患者的生存率。所以本文目的在于探讨先化疗后手术对NSCLC预后因素的影响。方法：回顾性收集我院1995年-1997年先化疗后手术的Ⅰ-Ⅲ期NSCLC住院病例98例，其中Ⅰ期35例、Ⅱ期21例、Ⅲ期42例，手术前先进行1和2周期化疗的分别为83例和15例，化疗方案为MVP、MOP或MAP等，化疗缓解率（RR），部分缓解（PR）45例，稳定（SD）53例，手术方式为肺叶切除或全肺切除，分站摘除所有肉眼可见的胸内淋巴结，手术病理提示鳞癌35例、腺癌48例、混合型9例、其他6例，术后化疗2—3个周期（1996年后Ⅰ期NSCLC术后未作化疗）。对先化疗后手术的98例NSCLC患者的临床资料，随访5年以上，运用Kaplan—Meier生存曲线分析，Log Rank检验和Cox多因素分析，对影响预后的因素进行单因素和多因素分析。结果：98例先化疗后手术NSCLC患者的中位随访时间为41．2月，其中36例存活，62例死亡。98例NSCLC患者的1年、3年、5年生存率分别是88．78％、49．63％、18．46％；Ⅰ、Ⅱ、Ⅲ期5年生存率分别为33．23％、20．26％、5．52％（P=0．0002）；N0、N1、N2组5年生存率分别为35．49％、19．08％、4．90％（P=0．0004）。先化疗后手术NSCLC总分期越晚预后越差；术前末次化疗距手术时间为1月内预后好；全肺切除较肺叶切除预后差；肺门固定较肺门活动预后差；胸内淋巴结（＋）预后差，N1较N0预后差，N2较N1预后更差；其它预后不良因素包括肿块侵犯大血管、脏器、胸壁、心包，术中出血量≥400ml，腺癌；化疗后肿块纤维化预后好。本组结果还显示：术前化疗2周期较术前化疗1周期预后好；肿瘤坏死和术后未行化疗者预后差。结论：影响先化疗后手术NSCLC患者的预后因素为：总分期、术前末次化疗距手术时间、术式、肺门活动度、胸内淋巴结、肿块侵犯部位、术中出血量、病理类型及肿瘤纤维化。术前化疗次数、肿瘤坏死和术后化疗亦可能是先化疗后手术NSCLC预后的影响因素。     

非小细胞肺癌预后影响因素分析

目的:探讨非小细胞肺癌(NSCLC)患者的预后相关因素。方法:对2005年6月-2006年6月我院收治的162例非小细胞肺癌患者的临床、病理资料进行回顾性研究,采用Kaplan-Meier和COX回归方法分析评价各因素对预后的影响。结果:单因素分析表明KPS评分、手术与否、临床分期、治疗状况及治疗前血小板(PLT)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)的水平与NSCLC患者的预后有关。多因素分析表明,临床分期、治疗状况、血小板及血清癌胚抗原的水平是独立的预后影响因素。临床分期Ⅳ期、未治疗、PLT>300×109/L、CEA>5.0μg/L时,相对危险度(RR)分别为5.524、16.096、3.563、2.607。结论:治疗前血小板、血清CEA的水平、临床分期及治疗情况是NSCLC患者独立的预后影响因素。     

非小细胞肺癌免疫治疗疗效预测的研究进展

近年来,免疫检查点抑制剂(immune checkpoint inhibitors,ICI)治疗晚期非小细胞肺癌进入了一个新纪元,但不同于靶向治疗,免疫治疗没有明确的疗效预测因子以指导临床。目前应用较多的是程序性死亡受体配体(programmed cell death ligand 1,PD-L1)表达的检测,然而多项临床试验结果提示只有约20%的NSCLC患者能从中获益。而肿瘤突变负荷(tumor mutation burden,TMB)也逐渐兴起,还有许多检测因子尚在发现中。本综述旨在探讨非小细胞肺癌中免疫治疗的疗效预测因子以更好地指导临床。     

外周血sCTLA-4作为晚期非小细胞肺癌患者的预后因子

目的:通过检测晚期非小细胞肺癌(non-small-cell lung cancer,NSCLC)患者外周血可溶性细胞毒性T淋巴细胞相关抗原4(soluble cytotoxic T lymphocyte associated antigen-4,sCTLA-4)的表达,探讨其与晚期NSCLC患者生存期的关系.方法:采集2010年8月至2013年6月上海中医药大学附属龙华医院肿瘤科经病理证实的58例晚期NSCLC患者和30例正常人的外周血,运用ELISA法检测血中sCTLA-4含量,通过电话随访或上海市疾控中心获得患者生存期数据,分析sCTLA-4表达与NSCLC生存期的关系.结果:NSCLC患者外周血sCTLA-4表达率高于正常人(70.7％ vs 6.7％,x2 =32.44,P＜0.01),外周血sCTLA-4增高的患者中位生存期(MST)较短(41.63个月vs 31.57个月,x2 =7.765,P＜0.01),死亡风险高于其他患者(RR =3.05,x2=8.01,P＜0.01).结论:NSCLC患者外周血中sCTLA-4高表达,sCTLA-4可能成为晚期NSCLC患者的预后因子之一.     

Interleukins as new prognostic genetic biomarkers in non-small cell lung cancer

Background

Surgery is the standard treatment for early-stage NSCLC, and platinum-based chemotherapy remains as the treatment of choice for advanced-stage NSCLC patients with naïve EGFR status. However, overall 5-years relative survival rates are low. Interleukins (ILs) are crucial for processes associated with tumor development. In NSCLC, IL1B, IL6, IL12A, IL13 and IL16 gene polymorphisms may contribute to individual variation in terms of patient survival. The purpose of this study was to evaluate the association between IL gene polymorphisms and survival in NSCLC patients.

Predictors for patterns of brain relapse and overall survival in patients with non-small cell lung cancer

Our goal was to investigate prognostic factors for different patterns of brain relapse and overall survival so that treatments could be tailored and treatment outcomes improved. We studied 292 patients with non-small cell lung cancer (NSCLC) who had symptomatic, solitary, or multiple brain metastases (isolated or not isolated from extracranial metastases) that had developed early (≦6 months) or late (>6 months) from initial diagnosis. Factors affecting patterns of relapse and survival were analyzed by univariate and multivariate analyses. Good ECOG performance status (PS) at the time of NSCLC diagnosis was the most important factor that predicted late (rather than early) relapse and improved survival, and was the only factor that predicted isolated brain metastases. Patients whose lungs showed a complete response (CR) to treatment had a higher rate of late brain relapses than non-responders (NR) did (67.3% vs. 7.8%, P < 0.001). CR patients also experienced a longer median overall survival than NR patients. Patients with late brain relapses showed better median survival times (18 months vs. 4 months, P < 0.0001) than patients with early relapses, and this was an independent factor by Cox regression analysis. Our findings provide a justification for enrolling patients with good PS and controlled lung lesions into clinical trials for the prevention of early, non-isolated brain relapse. More aggressive therapeutic approaches should be applied to patients with late, isolated and solitary relapses to improve both quality and quantity of life.     

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC     

Temporal trends in non-small cell lung cancer survival in Sweden

We modeled temporal trends in the 1- and 5-year survival of 32 499 patients with adenocarcinoma and squamous cell carcinoma of the lung in the Swedish Cancer Register between 1961 and 2000. The 1-year relative survival for adenocarcinoma improved from 37% for patients diagnosed 1961-1965 to 45% for those diagnosed 1996-2000 and from 39 to 45% for squamous cell carcinoma. The adjusted excess mortality ratios for the period 1996-2000 compared with 1961-1965 were 0.80 for adenocarcinoma and 0.81 for squamous cell carcinoma. Thus, a previous report in a Dutch study of a relatively worsening prognosis for adenocarcinoma over time could not be confirmed.     

Validation of C-reactive protein levels as a prognostic indicator for survival in a large cohort of pancreatic cancer patients

Background:

Recent evidence indicates that the host inflammatory response has an important role in the tumour progression. Elevated C-reactive protein (CRP) levels have been previously associated with poor prognosis in several cancer types including small-scale studies in pancreatic cancer (PC) patients. The purpose of the present study was to validate the prognostic impact of plasma CRP levels at date of diagnosis on cancer-specific survival (CSS) in a large cohort of PC patients.

Methods:

Data from 474 consecutive patients with adenocarcinoma of the pancreas, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. CSS was analysed using the Kaplan–Meier method. To evaluate the prognostic significance of plasma CRP levels, univariate and multivariate Cox analyses were applied.

Results:

High plasma CRP levels at diagnosis were significantly associated with well-established prognostic factors, including high tumour stage and tumour grade and the administration of chemotherapy (P<0.05). In univariate analysis, we observed that a high plasma CRP level was a consistent factor for poor CSS in PC patients (hazard ratio (HR)=2.21; 95% confidence interval (CI)=1.68–2.92, P<0.001). In multivariate analysis, tumour stage, grade, administration of chemotherapy, a high neutrophil–lymphocyte ratio and the highest quartile of CRP levels (HR=1.60, 95% CI=1.16–2.21; P=0.005) were identified as independent prognostic factors in PC patients.

Conclusion:

In conclusion, we confirmed a significant association of elevated CRP levels with poor clinical outcome in PC patients. Our results indicate that the plasma CRP level might represent a useful marker for patient stratification in PC management.     

Is a patient's self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975

BACKGROUND: The aim of this prognostic factor analysis was to investigate if a patient's self-reported health-related quality of life (HRQOL) provided independent prognostic information for survival in non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Pretreatment HRQOL was measured in 391 advanced NSCLC patients using the EORTC QLQ-C30 and the EORTC Lung Cancer module (QLQ-LC13). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap validation technique was used to assess the stability of the outcomes. RESULTS: The final multivariate Cox regression model retained four parameters as independent prognostic factors for survival: male gender with a hazard ratio (HR) = 1.32 (95% CI 1.03-1.69; P = 0.03); performance status (0 to 1 versus 2) with HR = 1.63 (95% CI 1.04-2.54; P = 0.032); patient's self-reported score of pain with HR= 1.11 (95% CI 1.07-1.16; P < 0.001) and dysphagia with HR = 1.12 (95% CI 1.04-1.21; P = 0.003). A 10-point shift worse in the scale measuring pain and dysphagia translated into an 11% and 12% increased in the likelihood of death respectively. A risk group categorization was also developed. CONCLUSION: The results suggest that patients' self-reported HRQOL provide independent prognostic information for survival. This finding supports the collection of such data in routine clinical practice.