Beyond survival: Prospective longitudinal insights into quality of life after hepatectomy for colorectal liver metastases.

Abstract

11122 Background: The long-term health related quality of life (QoL) after curative intent hepatectomy for high-risk colorectal liver metastases (CRLM) is not well described. Methods: This prospective single-center study enrolled patients with resectable CRLM with Clinical Risk Score ≥3. European Organization for Research and Treatment of Cancer QLQ-C30, LMC21, and EuroQol EQ-5D-5L were administered at preoperative and postoperative visits, and at 6, 12, 18, 24, and 36 months from hepatectomy. Patient characteristics at baseline along with colorectal cancer disease state were collected at each timepoint on a scale from no evidence of disease (NED) to progressive disease on best supportive care. Linear mixed models were used to examine the trajectory of QoL scores with disease state modeled as a time-varying variable. Results: From 297 consented, 146 were evaluable by completing preoperative and postoperative surveys. Median age was 52 years (IQR: 45, 63), 42% (n=61) were female, 84% (n=122) were Non-Hispanic White, 70% (n=102) had synchronous CRLM, and 80% (n=117) received hepatic artery infusion chemotherapy (HAIC). Overall, QLQ-C30 demonstrated decrease in global health from baseline at post-operative survey (p<0.05) with subsequent improvements until returning to pre-operative levels at 12 months. Similarly, self-assessed health state on EQ-VAS─ a visual analog scale from 0 to 100 that corresponds to worst and best health possible, respectively─ decreased post-operatively (p<0.05) with recovery to baseline by 6 months. Among NED patients, QLQ-C30 QoL scores recovered to pre-operative levels 6 months after hepatectomy, whereas those with recurrent cancer reported scores below baseline at every follow-up assessment (all p<0.05). On EQ-VAS, NED patients were comparable to baseline at 6 months and reported higher scores than baseline at 24 months (p=0.029). Patients with recurrence had similar EQ-VAS scores as baseline at 12 months but remained lower than NED patients at each timepoint (all p<0.05). HAIC did not impact QoL assessed by QLQ-C30 (p=0.725) or EQ-VAS (p=0.559) during follow-up. Conclusions: Health related QoL suffers in the immediate post-operative period before returning to pre-operative levels and exceeding it among patients without recurrence. While cancer recurrence significantly influenced patient experience, HAIC did not sway QoL. Comparison of self-assessed EQ-VAS scores stratified by cancer recurrence status, where 0 and 100 correspond to worst and best health possible, respectively. Time Point No Recurrence, QoL Estimate Cancer Recurrence, QoL Estimate P-value Pre-op 75.28 Post-op 66.45 6m 75.37 68.10 <0.05 12m 80.78 70.15 <0.05 18m 80.28 70.48 <0.05 24m 83.38 74.21 <0.05 36m 78.32 57.44 <0.05