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.

Pompili, C.; Jaques, L.; Callister, MEJ.; Franks, KN.; Brunelli, A.; Velikova, G.

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.

All Authors

Pompili, C.

Jaques, L.

Callister, MEJ.

Franks, KN.

Brunelli, A.

Velikova, G.

LTHT Author

Jacques, Laura
Callister, Matthew
Franks, Kevin
Brunelli, Alessandro

LTHT Department

Cardio-Respiratory
Respiratory Medicine
Oncology
Leeds Cancer Centre
Thoracic Surgery

Publication Date

2026

Item Type

Journal Article
Observational Study

Subject

LUNG NEOPLASMS , QUALITY OF LIFE , RADIOTHERAPY , CO-PRODUCTION , THORACOSCOPY , HOSPITALISATION , RADIOSURGERY , MEN , WOMEN , THORACIC SURGERY , AGED , FOLLOW-UP-STUDIES , MIDDLE AGED , CARCINOMA, NON-SMALL-CELL LUNG , OUTCOME ASSESSMENT , PROSPECTIVE STUDIES , HEALTH STATUS , PROGNOSIS , NEOPLASM STAGING , AGED, 80 AND OVER , PNEUMONECTOMY

Abstract

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.