年龄、严重合并症和功能障碍各自独立导致癌症患者生存率低下。
Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients.
作者信息
Wedding Ulrich, Röhrig Bernd, Klippstein Almuth, Pientka Ludger, Höffken Klaus
机构信息
Department for Internal Medicine II, Division of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany.
出版信息
J Cancer Res Clin Oncol. 2007 Dec;133(12):945-50. doi: 10.1007/s00432-007-0233-x. Epub 2007 May 30.
PURPOSE
With the increasing number of elderly patients suffering from cancer, comorbidity and functional impairment become common problems in patients with cancer. Both comorbidity and functional impairment are associated with a shorter survival time in cancer patients, but their independent role has rarely been addressed before.
METHODS
Within a prospective trial we recruited 427 cancer patients, irrespective of age and type of cancer, admitted as inpatients prior to the start of chemotherapy. Comorbidity was assessed with the cumulative illness rating scale (CIRS-G), functional impairment with WHO performance status (WHO-PS), basal (ADL) and instrumental (IADL) activities of daily living.
RESULTS
Median follow-up was 34.2 months. A total, 61.4%. of patients died. Median survival time was 21.0 months. Age, kind of tumour (solid vs. haematological), treatment approach (non-curative vs. curative), WHO-PS (2-4 vs. 0-1), IADL (<8 vs. 8), and severe comorbidity (CIRS-level 3-4 vs. none) were significantly associated with shorter survival time in univariate analysis. In a multivariate Cox-regression-analysis, age (HR 1.019; 95%-CI 1.007-1.032; P=0.003), kind of tumour (HR 1.832; 95%-CI 1.314-2.554; P<0.001), WHO-PS (HR 1.455; 95%-CI 1.059-2.000; P=0.021), and comorbidity level 3-4 (HR 1.424; 95%-CI 1.012-2.003; P=0.043) maintained their significant association.
CONCLUSIONS
Age, severe comorbidity, functional impairment, and kind of tumour are independently related to shorter survival time in cancer patients.
目的
随着患癌老年患者数量的增加，合并症和功能障碍成为癌症患者的常见问题。合并症和功能障碍均与癌症患者较短的生存时间相关，但它们的独立作用此前很少得到探讨。
方法
在一项前瞻性试验中，我们招募了427名癌症患者，无论其年龄和癌症类型如何，均为化疗开始前入院的住院患者。使用累积疾病评定量表（CIRS-G）评估合并症，使用世界卫生组织表现状态（WHO-PS）、基础日常生活活动能力（ADL）和工具性日常生活活动能力（IADL）评估功能障碍。
结果
中位随访时间为34.2个月。共有61.4%的患者死亡。中位生存时间为21.0个月。在单因素分析中，年龄、肿瘤类型（实体瘤与血液系统肿瘤）、治疗方法（非根治性与根治性）、WHO-PS（2 - 4级与0 - 1级）、IADL（<8分与8分）以及严重合并症（CIRS水平3 - 4级与无合并症）均与较短的生存时间显著相关。在多因素Cox回归分析中，年龄（HR 1.019；95%置信区间1.007 - 1.032；P = 0.003）、肿瘤类型（HR 1.832；95%置信区间1.314 - 2.554；P < 0.001）、WHO-PS（HR 1.455；95%置信区间1.059 - 2.000；P = 0.021）以及合并症3 - 4级（HR 1.424；95%置信区间1.012 - 2.003；P = 0.043）仍保持显著相关性。
结论
年龄、严重合并症、功能障碍和肿瘤类型与癌症患者较短的生存时间独立相关。
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