A comprehensive prognostic index to predict survival based on multiple comorbidities - A focus on breast cancer
A comprehensive prognostic index to predict survival based on multiple comorbidities - A focus on breast cancer
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DOI：
10.1097/00005650-199906000-00009
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发表时间：
1999-06-01
期刊：
影响因子：
3
通讯作者：
Johnson, KD
中科院分区：
文献类型：
--
作者：
Fleming, ST;Rastogi, A;Johnson, KD
背景合并症的存在经常影响临床决策，尽管许多研究为了分析而排除了合并症患者。本研究的目的是开发一个综合预后指数（CPT），专为乳腺癌patients.RESEARCH设计，这项研究与医疗保险索赔与肯塔基州癌症登记处，并开发了两个模型的基础上1年的生存率，一个集中在乳腺癌慢跑造成的死亡和其他死亡的所有原因。合并症来源于乳腺癌诊断前2年的住院和门诊索赔。研究对象包括1993年在肯塔基州首次诊断为乳腺癌的848名老年妇女。每个模型都确定了对生存不利的乳腺癌特有的合并症，并生成了一个精确的合并症指数。CPI将这些指标与癌症的年龄和阶段整合为一个综合的预后指数。近三分之二的患者有至少一种合并症的证据，正如预期的那样，生存率随着年龄的增长，更晚期和合并症负担的增加而下降。合并症负担与年龄或阶段的相互作用是特别强的老年人和更先进的阶段cancer.CONCLUSIONS，CPI可能是一个有用的工具，在乳腺癌干预研究和临床医生的预后援助。
BACKGROUND. The presence of comorbidities often influences clinical decision-making, although many studies exclude patients with comorbid disease for the sake of analysis.OBJECTIVES. The purpose of this study was to develop a Comprehensive Prognostic Index (CPT), designed specifically for breast cancer patients.RESEARCH DESIGN, This study linked Medicare claims with the Kentucky Cancer Registry and developed two models based on 1 year survival; one focused on deaths caused by breast canter and the other on deaths from all causes. Comorbidities were derived from inpatient and ambulatory claims for up to 2 years before the diagnosis of breast cancer.SUBJECTS. Subjects included a cohort of 848 elderly women first diagnosed with breast cancer in the state of Kentucky in 1993.MEASURES. Each model identified the comorbidities specific to breast cancer that were detrimental to survival, and generated a refined comorbidity index. The CPI integrated these measures with age and stage of cancer into a comprehensive prognostic index.RESULTS. Nearly two-thirds of the patients had evidence of at least one comorbidity, Survival rates decreased with age, more advanced stage, and increased comorbidity burden, as expected. The interaction of comorbidity burden with either age or stage was particularly strong for the older and more advanced stage of cancer.CONCLUSIONS, The CPI could be a useful tool in breast cancer intervention studies and a prognostic aid for clinicians.