Correlations of health-related quality of life with serum inflammatory indicators IL-8 and mIBI in patients with hepatocellular carcinoma

Leung Li,1 Stephen L Chan,1 Frankie Mo,1 Edwin P Hui,1 Jane Koh,1 Allen KC Chan,2 Nelson LS Tang,2 Kit F Lee,3 Paul BS Lai,3 Simon CH Yu,4 Winnie Yeo1 1Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR; 2Department of Chemical Pathology, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; 3Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR; 4Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR Purpose: Health-related quality of life (HRQoL) is a significant prognostic factor for overall survival in hepatocellular carcinoma (HCC) patients, and this is independent of stage and liver function. Inflammation plays a significant role in HCC development and progression. It was hypothesized that the inflammatory status of HCC patients may affect their HRQoL. The relationship between HRQoL and inflammatory status was explored using indicators IL-8 level and modified inflammation-based index (mIBI, based on IL-8, C-reactive protein, and albumin). Methods: From 2007–2011, HCC patients were enrolled prospectively. Baseline HRQoL assessment utilized the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-HCC18; clinical and laboratory data were collected at diagnosis. Two summary indices, C30 and HCC18 index-scores, were calculated. Correlation analyses were performed between HRQoL and inflammatory markers. Results: In the 445 patients studied, significant correlations were found between IL-8 levels and EORTC QLQ-C30, QLQ-HCC18, C30, and HCC18 index-scores. The strongest correlated factors were those reflective of constitutional symptoms, namely QLQ-C30 “appetite loss” (with Pearson’s correlation coefficient, r=0.322, P<0.0001); QLQ-C30 “fatigue” (r=0.311, P<0.0001); QLQ-C30 “role functioning” (r=−0.305, P<0.0001); QLQ-HCC18 “nutrition” (r=0.317, P<0.0001); and QLQ-HCC18 “fatigue” (r=0.306, P<0.0001). In addition, moderate but significant correlations were also observed with HCC18 index score (r=0.321, P<0.0001), and C30 index score (r=0.306, P<0.0001). HRQoL factors were also significantly correlated with mIBI. Conclusion: Baseline HRQoL using the conventional assessments of EORTC QLQ-C30 and QLQ-HCC18, as well as C30 and HCC18 index-scores, significantly correlated with inflammatory indicators (IL-8 level and mIBI) in HCC patients. Among the strongest correlations were those between IL-8 level and the two index-scores, as well as HRQoL aspects that represent constitutional symptoms. When paralleled with molecular findings, traditional HRQoL assessment in HCC has gained a new level of understanding: pattern recognition within an HRQoL instrument could potentially identify patients with more severe inflammatory state. Keywords: cytokine interleukin 8, index score, EORTC QLQ-C30, EORTC QLQ-HCC18, liver cancer, modified inflammation-based inde