Age and comorbidity as independent prognostic factors in the treatment of non-small-cell lung cancer: A review of national cancer institute of Canada clinical trials group trials
Age and comorbidity as independent prognostic factors in the treatment of non-small-cell lung cancer: A review of national cancer institute of Canada clinical trials group trials
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DOI：
10.1200/jco.2007.12.8322
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发表时间：
2008-01-01
影响因子：
45.3
通讯作者：
Goss, Glenwood D.
中科院分区：
文献类型：
--
作者：
Asmis, Timothy R.;Ding, Keyue;Goss, Glenwood D.
目的：本研究分析了两个大型的、前瞻性的、随机的、关于非小细胞肺癌（NSCLC）全身化疗（辅助/姑息治疗）的试验。主要目的是确定是否年龄和/或慢性疾病（合并症）的负担是独立的预测生存，治疗交付，和toxicity.Patients和方法基线共病条件进行了评分，使用的Charlson合并症指数（CCI），一个有效的措施，患者合并症的加权根据合并症对总死亡率的影响。CCI评分（CCIS）与人口统计学数据（即年龄、性别、种族）、体能状态（PS）、组织学、癌症分期、患者体重、血红蛋白、碱性磷酸酶、乳酸脱氢酶、化疗结果（即类型、总剂量和剂量强度）、生存率和反应相关。中位年龄为61岁（范围：34 - 89岁）; 34%的患者为老年人（至少65岁）; 31%的患者在随机化时患有合并症。25%的患者的CCIS为1，而6%的患者的CCIS为2或更高。与年轻患者相比，老年患者CCIS等于或大于1的可能性更大（42% vs26%; P < .0001），男性患者（35% vs21%; P < .0001）和鳞状组织学患者（36% vs29%; P = .001）也是如此。虽然年龄并不影响总生存率，但CCIS显示预后（CCIS 1 v0; hazard ratio 1.28; 95%CI，1.09 to 1.5; P = .003）。结论在这些大型随机试验中，存在共病（CCIS >= 1），而不是年龄超过65岁，与较差的生存率相关。
Purpose This study analyzed patients enrolled in two large, prospectively randomized trials of systemic chemotherapy (adjuvant/palliative setting) for non-small-cell lung Cancer (NSCLC). The main objective was to determine if age and/or the burden of chronic medical conditions (comorbidity) are independent predictors of survival, treatment delivery, and toxicity.Patients and Methods Baseline comorbid conditions were scored using the Charlson comorbidity index (CCI), a validated measure of patient comorbidity that is weighted according to the influence of comorbidity on overall mortality. The CCI score (CCIS) was correlated with demographic data,(ie, age, sex, race), performance status ( PS), histology, cancer stage, patient weight, hemoglobin, alkaline phosphatase, lactate dehydrogenase, outcomes of chemotherapy delivery ( ie, type, total dose, and dose intensity), survival, and response.Results A total of 1,255 patients were included in this analysis. The median age was 61 years (range, 34 to 89 years); 34% of patients were elderly ( at least 65 years of age); and 31% had comorbid conditions at randomization. Twenty-five percent of patients had a CCIS of 1, whereas 6% had a CCIS of 2 or greater. Elderly patients were more likely to have a CCIS equal to or greater than 1 compared with younger patients (42% v 26%; P < .0001), as were male patients (35% v 21%; P < .0001) and patients with squamous histology (36% v 29%; P = .001). Although age did not influence overall survival, the CCIS appeared prognostic (CCIS 1 v 0; hazard ratio 1.28; 95% CI, 1.09 to 1.5; P = .003).Conclusion In these large, randomized trials, the presence of comorbid conditions (CCIS >= 1), rather than age more than 65 years, was associated with poorer survival.