Impact of Comorbidities on Survival in Gastric, Colorectal, and Lung Cancer Patients.
Impact of Comorbidities on Survival in Gastric, Colorectal, and Lung Cancer Patients.
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DOI：
10.2188/jea.je20170241
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发表时间：
2019-03-05
影响因子：
4.7
通讯作者：
Miyashiro I
中科院分区：
文献类型：
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作者：
Morishima T;Matsumoto Y;Koeda N;Shimada H;Maruhama T;Matsuki D;Nakata K;Ito Y;Tabuchi T;Miyashiro I
癌症患者合并症的存在可能影响治疗决策和预后。本研究旨在探讨合并症对确诊为主要实体瘤的日本患者总生存率的影响。为了获得患者层面的临床状况和生命状态信息，我们将来自日本大阪府的基于人群的癌症登记数据与诊断程序组合（DPC）系统下产生的行政数据进行了记录链接。研究人群包括2010年至2012年间在五家癌症中心接受胃癌、结直肠癌或肺癌初步诊断的患者。我们采用Charlson合并症指数（CCI）评分来量化合并症对生存的影响。在调整患者性别、癌症诊断年龄和癌症分期后，使用全因死亡率的Cox比例风险回归模型分析每个癌症部位的CCI评分与生存率之间的关系。共分析了2609例患者，中位随访时间为1372天。患者CCI评分以0分（77.7%）最多，其次为2分（14.3%）。调整协变量后，我们发现CCI评分与全因死亡率之间存在显著关联。胃癌、结直肠癌和肺癌的CCI评分每增加1点的风险比分别为1.12（95%可信区间[CI]， 1.02-1.23）、1.20 （95% CI, 1.08-1.34）和1.14 （95% CI, 1.04-1.24）。合并症对癌症患者的总体生存期有负面影响，在报告预后时应将其作为死亡率的危险因素进行评估。
The presence of comorbidities in cancer patients may influence treatment decisions and prognoses. This study aimed to examine the impact of comorbidities on overall survival in Japanese patients diagnosed with major solid tumors. To obtain patient-level information on clinical conditions and vital status, we performed a record linkage of population-based cancer registry data from Osaka Prefecture, Japan and administrative data produced under the Diagnosis Procedure Combination (DPC) system. The study population comprised patients who received a primary diagnosis of gastric, colorectal, or lung cancer between 2010 and 2012 at any of five cancer centers. We employed the Charlson Comorbidity Index (CCI) score to quantify the impact of comorbidities on survival. The association between CCI score and survival for each cancer site was analyzed using Cox proportional hazards regression models for all-cause mortality, after adjusting for patient sex, age at cancer diagnosis, and cancer stage. A total of 2,609 patients with a median follow-up duration of 1,372 days were analyzed. The most frequent CCI score among the patients was 0 (77.7%), followed by 2 (14.3%). After adjusting for the covariates, we detected a significant association between CCI score and all-cause mortality. The hazard ratios per one-point increase in CCI score were 1.12 (95% confidence interval [CI], 1.02–1.23), 1.20 (95% CI, 1.08–1.34), and 1.14 (95% CI, 1.04–1.24) for gastric, colorectal, and lung cancer, respectively. Comorbidities have a negative prognostic impact on overall survival in cancer patients, and should be assessed as risk factors for mortality when reporting outcomes.