Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.
Postgrad Med J. 2010 Feb;86(1012):73-8. doi: 10.1136/pgmj.2009.084566.
Comorbid conditions in colorectal cancer patients can influence both clinical eligibility for treatment and survival. We aimed to evaluate the effect of comorbidity on 1 year survival from colorectal cancer, and to assess whether this effect varied with the timing of the comorbidity in relation to the cancer diagnosis.
A population based cohort of 29,563 colorectal cancer patients diagnosed between 1997 and 2004 in the North West of England was evaluated. The excess hazard of death up to 1 year after diagnosis was estimated using deprivation and region specific life tables to adjust for background mortality. Results were adjusted for age and stage at diagnosis.
Comorbid conditions diagnosed during the period 18 to 6 months before the diagnosis of colorectal cancer were strongly associated with lower survival at 1 year. Stage and age remained the strongest predictors of cancer related mortality even after adjustment for comorbidity.
Administrative data provide a good estimate of the prevalence of most comorbid conditions but may be biased for some comorbid conditions that can be contra-indicators for cancer treatment. The time window in which a comorbid condition occurs in relation to the cancer diagnosis should be taken into account. Adjustment should be carried out, where possible, to provide more robust and clinically appropriate comparisons of population based cancer patient survival.
结直肠癌患者的合并症会影响其治疗的临床适应证和生存情况。本研究旨在评估合并症对结直肠癌患者 1 年生存率的影响，并评估这种影响是否与合并症与癌症诊断的时间关系有关。
对 1997 年至 2004 年间在英格兰西北部确诊的 29563 例结直肠癌患者进行了一项基于人群的队列研究。利用贫困程度和区域特异性生命表，通过调整背景死亡率，评估了诊断后 1 年内死亡的超额风险。结果调整了诊断时的年龄和分期。
在结直肠癌诊断前 18 至 6 个月期间诊断出的合并症与 1 年生存率降低密切相关。即使在调整了合并症后，分期和年龄仍然是癌症相关死亡率的最强预测因素。
行政数据可以很好地估计大多数合并症的流行情况，但对于一些可能成为癌症治疗禁忌的合并症可能存在偏差。应考虑合并症与癌症诊断的时间关系。应进行调整，以提供更稳健且更符合临床实际的基于人群的癌症患者生存率比较。
