Quality of Life Research

, Volume 24, Issue 7, pp 1669–1675 | Cite as

Role functioning is associated with survival in patients with hepatocellular carcinoma

  • Adam Meier
  • Adam Yopp
  • Huram Mok
  • Pragathi Kandunoori
  • Jasmin Tiro
  • Amit G. Singal



Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL. Our study’s aim was to evaluate the association of QOL with survival among a cohort of cirrhotic patients with HCC that was diverse with respect to liver function and tumor stage.


We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30 and QLQ-HCC18, prior to the treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan–Meier analysis and compared using log rank test to determine whether QOL is associated with survival.


A total of 130 treatment-naïve patients completed both surveys. Patients reported high cognitive and social function (median scores 67) but poor global QOL (median score 50) and poor role function (median score 50). QOL was associated with cirrhosis-related (p = 0.02) and tumor-related (p = 0.02) components of Barcelona Clinic Liver Cancer (BCLC) tumor stage. QOL was associated with survival on univariate analysis (HR 0.37, 95 % CI 0.16–0.85) but became nonsignificant (HR 0.82, 95 % CI 0.37–1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95 % CI 0.20–0.81), after adjusting for Caucasian race (HR 0.31, 95 % CI 0.16–0.59), BCLC stage (HR 1.51, 95 % CI 0.21–1.89), and treatment (HR 0.57, 95 % CI 0.33–0.97).


Role function has prognostic significance and is important to assess in patients with HCC.


Liver cancer Quality of life Role function Prognosis 



This work was conducted with support from the National Center for Advancing Translational Sciences of the National Institutes of Health under award KL2TR001103. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

None of the authors have any conflict of interest relevant to this manuscript.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Adam Meier
    • 1
  • Adam Yopp
    • 2
    • 4
  • Huram Mok
    • 1
  • Pragathi Kandunoori
    • 1
  • Jasmin Tiro
    • 3
    • 4
  • Amit G. Singal
    • 1
    • 3
    • 4
    • 5
  1. 1.Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
  2. 2.Department of SurgeryUT Southwestern Medical CenterDallasUSA
  3. 3.Department of Clinical SciencesUT Southwestern Medical CenterDallasUSA
  4. 4.Harold C. Simmons Cancer CenterUT Southwestern Medical CenterDallasUSA
  5. 5.Division of Digestive and Liver Diseases, Dedman Scholar of Clinical CareUniversity of Texas Southwestern Medical CenterDallasUSA

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