Predictors of Pre- and Postoperative Quality of Life and Overall Survival in Patients with Non-Small Cell Lung Cancer: A Prospective Study.

[BACKGROUND/OBJECTIVES] Surgery is the most effective treatment for early-stage lung cancer but imposes a greater physical burden than other therapies. We previously identified socioclinical factors associated with reduced perioperative health-related quality of life (HR-QOL) in patients undergoing anatomical pulmonary resection. This study aimed to evaluate the relationship between predictors of HR-QOL and long-term survival.

[METHODS] In this prospective study, 87 patients undergoing anatomical pulmonary resection for non-small cell lung cancer at Shonan Kamakura General Hospital, Japan, were evaluated using the Short Form Health Survey 36. Multivariable analyses identified socioclinical factors associated with physical and mental QOL preoperatively and at 6 months postoperatively. Survival analyses were performed for factors showing differences in multivariable analysis and related trends in univariable analysis of HR-QOL.

[RESULTS] Preoperatively, lower performance status (PS) and living alone were independently associated with poorer physical QOL (regression coefficient [95% CI]: -10.94 [-14.34--7.54] and -9.86 [-13.89--5.82], respectively; both < 0.001) and mental QOL (-9.34 [-13.30--5.37] and -10.33 [-15.30--5.35]; both < 0.001). At 6 months postoperatively, smoking cessation within 1 year, lower PS, and living alone predicted worse physical QOL, while smoking cessation and lower PS predicted worse mental QOL. Lower PS and higher comorbidity burden were also adverse prognostic factors for long-term survival ( < 0.001 and = 0.015, respectively).

[CONCLUSIONS] Reduced physical activity and greater comorbidity are associated with poorer HR-QOL and survival after lung cancer surgery. These findings highlight the need for careful consideration of surgical indications in patients with these risk factors.