Patient-reported EORTC QLQ C-30 global health status decline predicts survival after video-assisted thoracoscopic (VATS) lung resection and stereotactic ablative radiotherapy (SABR): A 5 year follow-up from the Lilac study

Background

Early-stage non-small cell lung cancer (NSCLC) is increasingly treated with either video-assisted thoracoscopic surgery (VATS) or stereotactic ablative radiotherapy (SABR). While survival outcomes of these modalities have been widely studied, the prognostic significance of patient-reported outcomes (PROs), particularly short-term changes in global health status, remains underexplored in radically treated early-stage disease.

Methods

The Life after Lung Cancer (LiLac) study is a prospective observational cohort evaluating quality of life (QoL) trajectories in patients with clinical stage I-II NSCLC treated with VATS or SABR. QoL was assessed using the EORTC QLQ-C30 and LC13 at baseline and at 6 weeks, 3, 6, and 12 months. This analysis includes a 5-year survival follow-up of stage IA patients with available baseline and 6-week global health (GH) scores. Overall survival (OS), event-free survival (EFS), and lung cancer–specific survival (LCSS) were examined. A Fine–Gray competing risks model was used to identify predictors of lung cancer–specific mortality.

Results

A total of 142 patients were included (80 VATS; 62 SABR), with a median follow-up of 59 months. OS and EFS at 5 years were higher in surgical patients, while LCSS showed a favourable trend for VATS. A GH score decline > 10 points at 6 weeks were the only factor independently associated with lung cancer–specific death (SHR 5.77, p = 0.019), irrespective of treatment modality. No other QoL scales showed prognostic significance.

Conclusions

Early decline in patient-reported global health status after curative treatment for stage I NSCLC is a strong independent predictor of lung cancer–specific mortality. These findings support the integration of routine PRO assessment to inform risk stratification, recovery monitoring, and shared decision-making. Multicentre validation is warranted.