Dynamics trajectory of patient-reported quality of life and its associated risk factors among hepatocellular carcinoma patients receiving immune checkpoint inhibitors: a prospective cohort study

Abstract

Objective: We aimed to characterize quality of life (QOL) trajectories among patients with intermediate and advanced hepatocellular carcinoma patients treated with immunotherapy.

Methods: Barcelona Clinic Liver Cancer (BCLC) stage B-C HCC patients receiving immunotherapy at Guangxi Medical University Cancer Hospital were included. Trajectories of QOL, assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, were identified through iterative estimations of group-based trajectory models. Associations with trajectory group membership were analyzed using multivariable multinomial logistic regression.

Results: Three trajectory groups were identified (n=156): excellent (35.3%), poor (43.6%), and deteriorating (21.1%) QOL. The deteriorating trajectory group reported a mean QOL score of 124.79 (95% CI, 116.58-133.00), but then declined significantly at month-2 (estimated QOL score 98.67 [95% CI, 84.33-113.00]), and the lowest mean score is reached at month-6 (estimated QOL score 16.58 [95% CI, 0-46.07]). Factors associated with membership to the deteriorating group included no drinking (odds ratio [OR] vs yes [95% CI], 3.70 [1.28-11.11]), no received radiotherapy (OR vs yes [95% CI], 8.33 [1.41-50.00]), diabetes (OR vs no [95% CI], 6.83 [1.57-29.73]), and extrahepatic metastasis (OR vs no [95% CI], 3.08 [1.07-8.87]). Factors associated with membership to the poor group also included body mass index ≤24.0 kg/m² (OR vs no [95% CI], 4.49 [1.65-12.22]).

Conclusions: This latent-class analysis identified a high-risk cluster of patients with severe, persistent post-immunotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of immunotherapy and preserve QOL.

Keywords: hepatocellular carcinoma; immune checkpoint inhibitors; immunotherapy; quality of life; trajectory analysis.

Figure 1

Consort diagram of patient population. QOL, quality of life.

Figure 2

Trajectory groups according to best-fitting model (n=156). Solid lines represent the predicted trajectories, shadow shapes represent the respective 95% CIs, and dotted gray lines represent the mean score at basleline. FACT-Hep Summary Scores were available for 156 patients at baseline, and then among 156 at 2 months follow-up; 143 at 4 months follow-up; and 141 patients at 6 months follow-up. Higher scores reflect better QOL. FACT-Hep, Functional Assessment of Cancer Therapy - Hepatobiliary questionnaire; QOL, quality of life.

Figure 3

Mean QOL scores by trajectory group and by time point for FACT-Hep subscales. Solid lines represent the predicted trajectories, dotted gray lines represent the mean score at basleline. Higher scores indicate greater functionality. Respective 95% CIs for the means are available in Supplementary Table S5 . FACT-Hep, Functional Assessment of Cancer Therapy - Hepatobiliary questionnaire; QOL, quality of life.