Prognostic importance of Comorbidity in a hospital-based cancer registry
Prognostic importance of Comorbidity in a hospital-based cancer registry
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DOI：
10.1001/jama.291.20.2441
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发表时间：
2004-05-26
影响因子：
120.7
通讯作者：
Spitznagel, EL
中科院分区：
文献类型：
--
作者：
Piccirillo, JF;Tierney, RM;Spitznagel, EL
癌症患者通常有其他医学疾病，称为合并症。合并症可能会影响治疗决策，预后和护理assessment.Objective质量评估是否合并症的信息可以提供重要的预后信息，在医院为基础的癌症registration.Design，设置，和Participants一个观察性前瞻性队列研究，使用合并症的数据收集的培训医院为基础的癌症登记。合并症是通过使用成人合并症评估27（一种经验证的基于图表的合并症工具）的病历审查获得的。在1995年1月1日至2001年1月31日期间，共有17712名患者接受治疗，初步诊断为新的前列腺癌、肺癌和其他癌症。（非小细胞）、乳腺、消化系统、妇科、泌尿系统或头颈部均包括在内。主要结果测量总生存期（月）。结果共有19268例患者纳入研究;中位随访时间为31个月。在这些患者中，1556例（8.0%）因数据缺失或未知而被排除。合并症的严重程度以剂量依赖性方式强烈影响生存率，合并症的影响与癌症分期无关。与无合并症的患者相比，轻度合并症的校正风险比为1.21（95%置信区间[CI]，1.13-1.30），中度合并症为1.86（95% CI，1.73-2.00），重度合并症为2.56（95% CI，2.35-2.81）。校正后的Kaplan-Meier生存曲线显示，在任何时间点，合并症水平更严重的患者生存率更差（合并症导致的部分卡方检验，523.54; P
Context Patients with cancer often have other medical ailments, referred to as comorbidity. Comorbidity may impact treatment decision-making, prognosis, and quality of care assessment.Objective To assess whether comorbidity information can provide important prognostic information in a hospital-based cancer registry.Design, Setting, and Participants An observational prospective cohort study using comorbidity data collected by trained hospital-based cancer registrars. Comorbidity was obtained through medical record review using the Adult Comorbidity Evaluation 27, a validated chart-based comorbidity instrument. A total of 17712 patients receiving care between January 1, 1995, and January 31, 2001, for the primary diagnosis of new cancer of the prostate, lung (nonsmall cell), breast, digestive system, gynecological, urinary system, or head and neck were included.Main Outcome Measure Duration in months of overall survival.Results A total of 19268 patients were included in the study; median duration of follow-up was 31 months. Of these patients, 1556 (8.0%) were excluded due to missing or unknown data. Severity of comorbidity strongly influenced survival in a dose-dependent fashion and the impact of comorbidity was independent of cancer stage. Compared with patients without comorbidity, the adjusted hazard ratio associated with mild comorbidity was 1.21 (95% confidence interval [Cl], 1.13-1.30), moderate comorbidity was 1.86 (95% Cl, 1.73-2.00), and severe comorbidity was 2.56 (95% Cl, 2.35-2.81). Adjusted Kaplan-Meier survival curves revealed that at any point in time the patients with more severe levels of comorbidity had worse survival (partial chi(3)(2) due to comorbidity, 523.54; P