King's College London, School of Medicine, Thames Cancer Registry, 42 Weston Street, London, United Kingdom.
Eur J Cancer. 2012 Dec;48(18):3386-95. doi: 10.1016/j.ejca.2012.06.012. Epub 2012 Jul 13.
To quantify the effect of comorbidity on stage-specific survival in resected non-small cell lung cancer (NSCLC) patients.
From the Danish Lung Cancer Registry, 20,461 patients diagnosed with lung cancer between 1st January 2005 and 31st December 2010 were identified. Among 3152 NSCLC patients who underwent surgical resection, mortality hazard ratios were calculated during three consecutive time periods following surgery (0-1 month, 1 month-1 year and >1 year) according to Charlson comorbidity score (CCS 0, 1, 2, 3+), Eastern Cooperative Oncology Group (ECOG) performance status, lung function, age, sex, pathological T (pT) and N (pN) stage using Cox proportional hazard modelling. The Kaplan Meier method was used to describe stage-specific survival according to the CCS.
Severe comorbidity (CCS 3+) was independently associated with significantly higher death rates throughout the three periods of follow-up [Hazard ratio (HR) 2.06 (1.13-3.75) for CCS 3+ in 0-1 month, 1.57 (1.17-2.12) 3+ during1 month-1 year and 1.84 (1.42-2.37) after 1 year]. Stage-specific 5-year survival in patients with severe comorbidity was significantly lower than in patients without comorbid disease [e.g. 38% (95% confidence interval (CI) 23-53%) for pT1 and CCS 3+ versus 69% (62-75%) for pT1 and CCS 0].
Severe comorbidity affects survival of NSCLC patients who undergo surgical resection by as much as a single stage increment and this effect persists throughout follow-up. Further research may be necessary to help identify which patients are most likely to benefit from surgery.
定量研究合并症对接受手术治疗的非小细胞肺癌（NSCLC）患者的特定分期生存的影响。
从丹麦肺癌登记处确定了 20461 名于 2005 年 1 月 1 日至 2010 年 12 月 31 日期间诊断为肺癌的患者。在接受手术切除的 3152 例 NSCLC 患者中，根据 Charlson 合并症评分（CCS 0、1、2、3+）、东部肿瘤协作组（ECOG）表现状态、肺功能、年龄、性别、病理 T（pT）和 N（pN）期，在手术后连续三个时间段（0-1 个月、1 个月-1 年和>1 年）计算死亡率风险比，使用 Cox 比例风险模型。采用 Kaplan-Meier 方法根据 CCS 描述特定分期的生存情况。
严重合并症（CCS 3+）与三个随访期内的死亡率显著升高独立相关[CCS 3+在 0-1 个月时的 HR 为 2.06（1.13-3.75），1 个月-1 年时的 HR 为 1.57（1.17-2.12），1 年后的 HR 为 1.84（1.42-2.37）]。患有严重合并症的患者的特定分期 5 年生存率明显低于无合并症的患者[例如，CCS 3+和 pT1 的 38%（95%置信区间（CI）23-53%）与 CCS 0 和 pT1 的 69%（62-75%）相比]。
严重合并症通过使 NSCLC 患者的手术分期增加一个阶段来影响生存，这种影响在整个随访期间持续存在。可能需要进一步研究以帮助确定哪些患者最有可能从手术中受益。
