Association between preoperative EQ-5D visual analogue scale score and recurrence-free survival after lung cancer resection

OBJECTIVE: To investigate the prognostic impact of preoperative self-reported global health status, assessed with the EQ-5D visual analogue scale (VAS), on recurrence-free survival (RFS) in patients undergoing resection for clinical stage I non-small cell lung cancer (NSCLC). METHODS: This retrospective study included 200 patients from a single-center quality-of-life assessment cohort who underwent complete resection for clinical stage I NSCLC between January 2015 and April 2018. Preoperative QOL was assessed with the EQ-5D-5L. RFS was analyzed with the Kaplan-Meier method and the Cox proportional hazards model. Competing risk analysis was performed to distinguish recurrence from mortality due to other causes. RESULTS: The median follow-up was 6.0 years and the 5-year RFS rate was 82.2% (42 events). On univariable Cox analysis for RFS, the hazard ratio (HR) per 1-unit decrease in EQ-5D VAS scores was 1.020(95% CI 1.002-1.039). An EQ-5D VAS score ≤55 was also associated with worse RFS (HR 2.762, 95% CI 1.271-6.005; p = 0.010). On competing risk analysis adjusting for Performance Status, and modified Glasgow Prognostic Score, the recurrence risk of lung cancer was significantly higher in the VAS ≤55 group (adjusted HR 3.45, 95% CI 1.09-10.96), whereas mortality from other causes was comparable between the 2 VAS groups. CONCLUSIONS: Lower preoperative EQ-5D VAS scores were associated with poorer recurrence-free survival in patients with clinical stage I NSCLC, driven primarily by increased recurrence rather than by other-cause mortality.