Nilsson Jonas, Berglund Anders, Bergström Stefan, Bergqvist Michael, Lambe Mats
a Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital , Gävle , Sweden.
b Department of Radiation Sciences and Oncology , Umeå University Hospital , Umeå , Sweden.
Acta Oncol. 2017 Jul;56(7):949-956. doi: 10.1080/0284186X.2017.1324213. Epub 2017 May 9.
Coexisting disease constitutes a challenge for the provision of optimal cancer care. The influence of comorbidity on lung cancer management and prognosis remains incompletely understood. We assessed the influence of comorbidity on treatment intensity and prognosis in a population-based setting in patients with nonsmall cell lung cancer.
Our study was based on information available in Lung Cancer Data Base Sweden (LcBaSe), a database generated by record linkage between the National Lung Cancer Register (NLCR) and several other population-based registers in Sweden. The NLCR includes data on clinical characteristics on 95% of all patients with lung cancer in Sweden since 2002. Comorbidity was assessed using the Charlson Comorbidity Index. Logistic regression and time to event analysis was used to address the association between comorbidity and treatment and prognosis.
In adjusted analyses encompassing 19,587 patients with a NSCLC diagnosis and WHO Performance Status 0-2 between 2002 and 2011, those with stage-IA-IIB disease and severe comorbidity were less likely to be offered surgery (OR: 0.45; 95% CI: 0.36-0.57). In late-stage disease (IIIB-IV), severe comorbidity was also associated with lower chemotherapy treatment intensity (OR: 0.76; 95% CI: 0.65-0.89). In patients with early, but not late-stage disease, severe comorbidity in adjusted analyses was associated with an increased all-cause mortality, while lung cancer-specific mortality was largely unaffected by comorbidity burden.
Comorbidity contributes to the poor prognosis in NSCLC patients. Routinely published lung cancer survival statistics not considering coexisting disease conveys a too pessimistic picture of prognosis. Optimized management of comorbid conditions pre- and post-NSCLC-specific treatment is likely to improve outcomes.
并存疾病对提供最佳癌症治疗构成挑战。合并症对肺癌管理和预后的影响仍未完全了解。我们在基于人群的非小细胞肺癌患者中评估了合并症对治疗强度和预后的影响。
我们的研究基于瑞典肺癌数据库（LcBaSe）中的可用信息，该数据库是通过将国家肺癌登记处（NLCR）与瑞典其他几个基于人群的登记处进行记录链接而生成的。NLCR包含自2002年以来瑞典95%肺癌患者的临床特征数据。使用Charlson合并症指数评估合并症。采用逻辑回归和事件发生时间分析来探讨合并症与治疗及预后之间的关联。
在2002年至2011年间纳入19587例诊断为非小细胞肺癌且世界卫生组织体能状态为0 - 2的患者的校正分析中，患有IA - IIB期疾病且合并症严重的患者接受手术的可能性较小（比值比：0.45；95%置信区间：0.36 - 0.57）。在晚期疾病（IIIB - IV期）中，严重合并症也与较低的化疗治疗强度相关（比值比：0.76；95%置信区间：0.65 - 0.89）。在早期但非晚期疾病患者中，校正分析显示严重合并症与全因死亡率增加相关，而肺癌特异性死亡率在很大程度上不受合并症负担的影响。
合并症导致非小细胞肺癌患者预后不良。常规公布的不考虑并存疾病的肺癌生存统计数据传达了过于悲观的预后情况。在非小细胞肺癌特异性治疗前后对合并症进行优化管理可能会改善预后。
