Prognostic value for overall survival of the EORTC QLQ-C30 Summary Score: An analysis of 5 closed EORTC trials.

Scheepens JCC, Lim L, Musoro JZ, Aaronson NK, Dirven L, Baumert BG, Bjelic-Radisic V, Bolla M, Coens C, Galinsky J, van der Graaf WTA, Husson O, Kyriakou C, O'Brien M, Rammant E, Turhal NS, Petersen MA, Grønvold M, Taphoorn MJB, Koekkoek JAF, Giesinger JM; EORTC Quality of Life Group. Prognostic value for overall survival of the EORTC QLQ-C30 Summary Score: An analysis of 5 closed EORTC trials. Eur J Cancer. 2026 Apr 30;241:116774. doi: 10.1016/j.ejca.2026.116774.

Background: The EORTC QLQ‑C30 Summary Score (Summary Score) aggregates 13 functioning and symptom scales to measure overall health-related quality of life (HRQoL). We assessed its baseline prognostic contribution for overall survival (OS) alongside the global health status/quality of life (Global Health/QoL) and other QLQ-C30 scales. 

Methods: We pooled HRQoL data from five randomized trials including five cancer types (n = 1863). Multivariable Cox proportional hazards models were adjusted for age, sex, WHO performance status, metastatic status, and cancer type. QLQ-C30 scales were selected using stepwise backward elimination, with bootstrap validation (500 resamples) assessing stability. To avoid multicollinearity, the Summary Score and Global Health/QoL scale were evaluated in separate models, with an additional bootstrap analysis comparing their stability. Discriminative performance was assessed using Harrell's C-index. 

Results: In separate multivariable models, the Summary Score (HR 0.904, 95% CI 0.869-0.939) and Global Health/QoL (HR 0.951, 95% CI 0.925-0.977) were retained as independent predictors, as well as Physical Functioning (HR 0.926, 95% CI 0.896-0.957) and Appetite Loss (HR 1.035, 95% CI 1.011-1.058). The Summary Score was retained in 96.6% of bootstrap samples versus 9.0% for Global Health/QoL. Compared with the clinical model (C = 0.603), C-indices increased to 0.637 with the Summary Score, 0.622 with Global Health/QoL, and 0.641 with Physical Functioning and Appetite Loss. 

Conclusion: The Summary Score, Physical Functioning, and Appetite Loss improve OS prediction beyond clinical factors. Although Global Health/QoL showed similar discrimination, the Summary Score demonstrated greater stability and may be preferable for robust risk stratification. 

Keywords: Cancer; EORTC QLQ-C30; Overall survival; Patient-reported outcome; Prognostic value; QLQ-C30 Summary Score. 

Copyright © 2026. Published by Elsevier Ltd.