Castro Mario A F, Dedivitis Rogério A, Ribeiro Karina C B
Service of Head and Neck Surgery, Hospital Ana Costa, and Division of Head and Neck Surgery, Irmandade da Santa Casa da Misericórdia de Santos, Brazil.
ORL J Otorhinolaryngol Relat Spec. 2007;69(3):146-52. doi: 10.1159/000099223. Epub 2007 Jan 30.
INTRODUCTION: The evaluation of a cancer patient can be affected by many factors. Cancer patients often have other diseases or medical conditions in addition to their cancer. These conditions are referred to as comorbidities. They can influence the treatment option, the rate of complications, the outcome, and can confound the survival analysis. OBJECTIVE: It was the aim of this study to measure comorbidities in patients with laryngeal squamous cell carcinoma. PATIENTS AND METHODS: Ninety adult patients treated for newly diagnosed laryngeal squamous cell carcinoma were studied. We measured comorbid illness applying the following validated scales: the Cumulative Illness Rating Scale (CIRS), the Kaplan-Feinstein Classification (KFC), the Charlson index, the Index of Coexistent Disease (ICED), the Adult Comorbidity Evaluation-27 (ACE-27), the Alcohol-Tobacco-Related Comorbidities Index (ATC), and the Washington University Head and Neck Comorbidity Index (WUHNCI). Survival analysis was performed using the Kaplan-Meier method (with the log-rank test value being used to compare groups). The Cox proportional hazards model was chosen to identify independent prognostic factors. RESULTS: The mean age was 62.3 years. The majority of patients (36.7%) had early tumors. Forty patients were treated by surgery only, while the remaining 49 patients also received postoperative radiation therapy. Only 5 patients (5.6%) were lost to follow-up. Median follow-up time was 42.5 months. The 4-year overall survival was 63%. There was a statistically significant difference between survival rates according to clinical stage (CS I 87.3%, CS II 48.9%, CS III 74.7%, CS IV 23.9%; p < 0.001). Patients treated by surgery only presented a better survival rate (79.6%) than those receiving postoperative radiation therapy (48.9%; p = 0.001). A statistically significant difference in survival rates was also noted when patients were analyzed according to the type of surgical procedure. In a univariate analysis, comorbidity had impact on prognosis, no matter which scale was utilized: CIRS (p = 0.008), ACE-27 (p = 0.010), ATC (p = 0.004), WUHNCI (p = 0.003), Charlson index (p = 0.020), KFC (p = 0.001), and ICED (p = 0.010). However, in the multivariate analysis, only CIRS and TNM staging were identified as independent prognostic factors. CONCLUSION: The comorbidity is an independent prognostic factor in patients with surgically treated laryngeal cancer. In the univariate analysis, all indexes were able to stratify patients. However, in the multiple analysis, only the CIRS was predictive of death. Comorbidities are an important factor in the analysis of overall survival.
引言:癌症患者的评估可能受到多种因素影响。癌症患者除了患有癌症外,通常还患有其他疾病或病症。这些情况被称为合并症。它们会影响治疗方案、并发症发生率、治疗结果,并且可能混淆生存分析。 目的:本研究旨在测量喉鳞状细胞癌患者的合并症情况。 患者与方法:对90例新诊断为喉鳞状细胞癌并接受治疗的成年患者进行研究。我们使用以下经过验证的量表来测量合并症:累积疾病评定量表(CIRS)、卡普兰 - 费因斯坦分类法(KFC)、查尔森指数、共存疾病指数(ICED)、成人合并症评估 - 27(ACE - 27)、酒精 - 烟草相关合并症指数(ATC)以及华盛顿大学头颈合并症指数(WUHNCI)。采用Kaplan - Meier方法进行生存分析(使用对数秩检验值比较组间差异)。选择Cox比例风险模型来确定独立的预后因素。 结果:平均年龄为62.3岁。大多数患者(36.7%)患有早期肿瘤。40例患者仅接受手术治疗,其余49例患者还接受了术后放疗。仅5例患者(5.6%)失访。中位随访时间为42.5个月。4年总生存率为63%。根据临床分期,生存率存在统计学显著差异(I期87.3%,II期48.9%,III期74.7%,IV期23.9%;p < 0.001)。仅接受手术治疗的患者生存率(79.6%)高于接受术后放疗的患者(48.9%;p = 0.001)。根据手术方式分析患者时,生存率也存在统计学显著差异。在单因素分析中,无论使用哪种量表,合并症均对预后有影响:CIRS(p = 0.008)、ACE - 27(p = 0.010)、ATC(p = 0.004)、WUHNCI(p = 0.003)、查尔森指数(p = 0.020)、KFC(p = 0.001)和ICED(p = 0.010)。然而,在多因素分析中,仅CIRS和TNM分期被确定为独立的预后因素。 结论:合并症是接受手术治疗的喉癌患者的独立预后因素。在单因素分析中,所有指标都能够对患者进行分层。然而,在多因素分析中,只有CIRS能够预测死亡。合并症是总生存分析中的一个重要因素。
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