Prognostic value for overall survival of the EORTC QLQ-C30 Summary Score: An analysis of 5 closed EORTC trials
BACKGROUND: The EORTC QLQ‑C30 Summary Score (Summary Score) aggregates 13 functioning and symptom scales to measure overall health-related quality of life (HRQoL). We assessed its baseline prognostic contribution for overall survival (OS) alongside the global health status/quality of life (Global Health/QoL) and other QLQ-C30 scales. METHODS: We pooled HRQoL data from five randomized trials including five cancer types (n = 1863). Multivariable Cox proportional hazards models were adjusted for age, sex, WHO performance status, metastatic status, and cancer type. QLQ-C30 scales were selected using stepwise backward elimination, with bootstrap validation (500 resamples) assessing stability. To avoid multicollinearity, the Summary Score and Global Health/QoL scale were evaluated in separate models, with an additional bootstrap analysis comparing their stability. Discriminative performance was assessed using Harrell's C-index. RESULTS: In separate multivariable models, the Summary Score (HR 0.904, 95% CI 0.869-0.939) and Global Health/QoL (HR 0.951, 95% CI 0.925-0.977) were retained as independent predictors, as well as Physical Functioning (HR 0.926, 95% CI 0.896-0.957) and Appetite Loss (HR 1.035, 95% CI 1.011-1.058). The Summary Score was retained in 96.6% of bootstrap samples versus 9.0% for Global Health/QoL. Compared with the clinical model (C = 0.603), C-indices increased to 0.637 with the Summary Score, 0.622 with Global Health/QoL, and 0.641 with Physical Functioning and Appetite Loss. CONCLUSION: The Summary Score, Physical Functioning, and Appetite Loss improve OS prediction beyond clinical factors. Although Global Health/QoL showed similar discrimination, the Summary Score demonstrated greater stability and may be preferable for robust risk stratification.
Authors
- Johan A F Koekkoek (ORCID: https://orcid.org/0000-0002-3648-9616)
- Johannes M. Giesinger (ORCID: https://orcid.org/0000-0003-2744-5950)
- Linda Dirven (ORCID: https://orcid.org/0000-0001-9157-9895)
- Elke Rammant (ORCID: https://orcid.org/0000-0001-6130-2502)
- Corneel Coens (ORCID: https://orcid.org/0000-0001-7601-5450)
- Winette T.A. van der Graaf (ORCID: https://orcid.org/0000-0001-7549-3338)
- Martin Taphoorn (ORCID: https://orcid.org/0000-0001-9949-4722)
- Nazım Serdar Turhal (ORCID: https://orcid.org/0000-0002-1013-5676)
- M. Bolla (ORCID: https://orcid.org/0000-0003-1727-8773)
- Neil K. Aaronson (ORCID: https://orcid.org/0000-0003-2574-4850)
- Luigi Lim
- Olga Husson
- Morten Aa. Petersen
- Mogens Grønvold (ORCID: https://orcid.org/0000-0002-3153-780X)
- Jayne Galinsky (ORCID: https://orcid.org/0009-0003-6047-0098)
- Jammbe Z. Musoro (ORCID: https://orcid.org/0000-0002-6228-3531)
- Brigitta G. Baumert
- Charalampia Kyriakou
- Vesna Bjelic-Radisic
- Josien C.C. Scheepens (ORCID: https://orcid.org/0000-0002-9403-9947)
- Mary O’Brien (ORCID: https://orcid.org/0000-0002-8557-8957)
Institutions
- National Health Service (GB)
- Anadolu University (TR)
- University College London Hospitals NHS Foundation Trust (GB)
- Vrije Universiteit Brussel (BE)
- Universität Innsbruck (AT)
- Leiden University Medical Center (NL)
- Centre Hospitalier Universitaire de Grenoble (FR)
- Frederiksberg Hospital (DK)
- The Netherlands Cancer Institute (NL)
- Ghent University (BE)
- Helios Universitätsklinikum Wuppertal (DE)
- European Organisation for Research and Treatment of Cancer (BE)
- European Federation of Allergy and Airways Diseases Patients Associations (BE)
- Erasmus MC Cancer Institute (NL)
- Maastro Clinic (NL)
- University Hospital Innsbruck (AT)
- University College London (GB)
- Istanbul University (TR)
Publication Details
- Journal
- European Journal of Cancer
- Published
- 2026-04-30
- DOI
- https://doi.org/10.1016/j.ejca.2026.116774
- Primary Topic
- Inflammatory Biomarkers in Disease Prognosis
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- European Organisation for Research and Treatment of Cancer