国家癌症数据库中接受手术治疗的乳腺癌、结直肠癌或肺癌患者的合并症评估（AFT-01、-02、-03）。
Comorbidity Assessment in the National Cancer Database for Patients With Surgically Resected Breast, Colorectal, or Lung Cancer (AFT-01, -02, -03).
机构信息
University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO.
出版信息
J Oncol Pract. 2018 Oct;14(10):e631-e643. doi: 10.1200/JOP.18.00175. Epub 2018 Sep 12.
PURPOSE
Accurate comorbidity measurement is critical for cancer research. We evaluated comorbidity assessment in the National Cancer Database (NCDB), which uses a code-based Charlson-Deyo Comorbidity Index (CCI), and compared its prognostic performance with a chart-based CCI and individual comorbidities in a national sample of patients with breast, colorectal, or lung cancer.
PATIENTS AND METHODS
Through an NCDB Special Study, cancer registrars re-abstracted perioperative comorbidities for 11,243 patients with stage II to III breast cancer, 10,880 with stage I to III colorectal cancer, and 9,640 with stage I to III lung cancer treated with definitive surgical resection in 2006-2007. For each cancer type, we compared the prognostic performance of the NCDB code-based CCI (categorical: 0 or missing data, 1, 2+), Special Study chart-based CCI (continuous), and 18 individual comorbidities in three separate Cox proportional hazards models for postoperative 5-year overall survival.
RESULTS
Comorbidity was highest among patients with lung cancer (13.2% NCDB CCI 2+) and lowest among patients with breast cancer (2.8% NCDB CCI 2+). Agreement between the NCDB and Special Study CCI was highest for breast cancer (rank correlation, 0.50) and lowest for lung cancer (rank correlation, 0.40). The NCDB CCI underestimated comorbidity for 19.1%, 29.3%, and 36.2% of patients with breast, colorectal, and lung cancer, respectively. Within each cancer type, the prognostic performance of the NCDB CCI, Special Study CCI, and individual comorbidities to predict postoperative 5-year overall survival was similar.
CONCLUSION
The NCDB underestimated comorbidity in patients with surgically resected breast, colorectal, or lung cancer, partly because the NCDB codes missing data as CCI 0. However, despite underestimation of comorbidity, the NCDB CCI was similar to the more complete measures of comorbidity in the Special Study in predicting overall survival.
目的
准确的合并症测量对于癌症研究至关重要。我们评估了国家癌症数据库（NCDB）中的合并症评估，该数据库使用基于代码的 Charlson-Deyo 合并症指数（CCI），并将其预后性能与基于图表的 CCI 和个体合并症在全国范围内接受乳腺癌、结直肠癌或肺癌根治性手术治疗的患者样本中进行了比较。
方法
通过 NCDB 特别研究，癌症登记员重新提取了 11243 例 II 期至 III 期乳腺癌、10880 例 I 期至 III 期结直肠癌和 9640 例 I 期至 III 期肺癌患者的围手术期合并症，这些患者于 2006-2007 年接受了确定性手术切除治疗。对于每种癌症类型，我们比较了 NCDB 基于代码的 CCI（分类：0 或缺失数据、1、2+）、特别研究基于图表的 CCI（连续）和 18 种个体合并症在三个单独的 Cox 比例风险模型中的预后性能，用于术后 5 年总生存率。
结果
肺癌患者的合并症发生率最高（NCDB CCI 2+，13.2%），乳腺癌患者的合并症发生率最低（NCDB CCI 2+，2.8%）。NCDB 和特别研究 CCI 之间的一致性以乳腺癌最高（秩相关系数，0.50），以肺癌最低（秩相关系数，0.40）。NCDB CCI 低估了 19.1%、29.3%和 36.2%的乳腺癌、结直肠癌和肺癌患者的合并症。在每种癌症类型中，NCDB CCI、特别研究 CCI 和个体合并症预测术后 5 年总生存率的预后性能相似。
结论
NCDB 低估了接受乳腺癌、结直肠癌或肺癌根治性手术治疗的患者的合并症，部分原因是 NCDB 代码将缺失数据标记为 CCI 0。然而，尽管合并症被低估，NCDB CCI 在预测总体生存率方面与特别研究中更完整的合并症测量方法相似。
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