Sabin S L, Rosenfeld R M, Sundaram K, Har-el G, Lucente F E
Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, USA.
Ear Nose Throat J. 1999 Aug;78(8):578, 581-4.
Previous studies have evaluated the effects of comorbidity on survival in patients with cancer. We applied the Charlson comorbidity index (CCI) to a cohort of patients with laryngeal cancer to validate its use and to assess the prognostic impact of age. Our study population consisted of 152 patients with laryngeal cancer who were seen over a 10-year period. Patients were assigned CCI scores and were categorized into low- and high-grade comorbidity groups for comparison. Age adjustments were performed by adding 1 point to the Charlson score for each decade over the median age. Low- vs. high-grade comorbidity was a valid predictor of survival independent of TNM (tumor, nodes, and metastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. High-grade comorbidity was present in 26 patients; their median survival was 8 months (p = 0.0002). The addition of the age factor to the CCI did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups. We conclude that the CCI is a strong predictor of survival in patients with laryngeal cancer. The confounding effects of comorbidity should be considered in the TNM staging of laryngeal cancer to improve our prognostic ability. Further investigations are necessary to assess the validity of this index in patients with other head and neck cancers.
以往的研究评估了合并症对癌症患者生存的影响。我们将Charlson合并症指数（CCI）应用于一组喉癌患者，以验证其用途并评估年龄的预后影响。我们的研究人群包括152例在10年期间就诊的喉癌患者。为患者分配CCI评分，并将其分为低级别和高级别合并症组进行比较。通过在Charlson评分基础上，每超过中位年龄一个十年增加1分来进行年龄调整。低级别与高级别合并症是独立于TNM（肿瘤、淋巴结和转移）分期的生存有效预测指标。126例患者存在低级别合并症；他们的中位生存期为41个月。26例患者存在高级别合并症；他们的中位生存期为8个月（p = 0.0002）。在CCI中加入年龄因素并未提高我们的预后预测能力。在CCI组之间，关于烟草和酒精使用、性别、治疗方式或平均复发时间没有差异。两组并发症的发生率和严重程度也相似。我们得出结论，CCI是喉癌患者生存的有力预测指标。在喉癌的TNM分期中应考虑合并症的混杂效应，以提高我们的预后预测能力。有必要进一步研究评估该指数在其他头颈癌患者中的有效性。
