合并症负担和与鼻-鼻窦癌全因死亡率相关的非临床因素。

Comorbidity burden and nonclinical factors associated with sinonasal cancer all-cause mortality.

机构信息

Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A.

Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A.

出版信息

Laryngoscope. 2020 Jun;130(6):1443-1449. doi: 10.1002/lary.28223. Epub 2019 Aug 14.

DOI:10.1002/lary.28223

PMID:31411750

Abstract

OBJECTIVE

To describe comorbidity burden and nonclinical factors associated with all-cause mortality of sinonasal cancer in the United States.

METHODS

The National Cancer Database (2004-2013) was queried for adult cases of sinonasal cancer (n = 10,518). Outcome of interest was all-cause mortality. Independent variables included comorbidity score and nonclinical factors such as age, gender, race, facility type, distance to facility, insurance, and income. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustments.

RESULTS

Patients were mostly (79%), male (61%), and mean age of diagnosis was 63.5 years. Approximately one in five patients (18.7%) had a major comorbid condition (Charlson-Deyo score ≥ 1) at diagnosis. After adjusting for clinical factors, increasing comorbidity score was associated with a corresponding increase in hazard of mortality (aHR comorbidity score of 1 = 1.25; 95% CI, 1.16, 1.35), (aHR score of 2+ = 1.61; 95%, CI 1.41, 1.83). Hazard of mortality was also associated with being male (aHR = 1.11; 95% CI, 1.04, 1.17); black (aHR = 1.13, 95% CI, 1.03, 1.24); uninsured (aHR = 1.45; 95% CI, 1.25, 1.68) or on Medicaid (aHR = 1.50; 95% CI, 1.33, 1.69); residence in zip codes with lower median income quartile (aHR < $30,000 = 1.17; 95% CI, 1.06, 1.29); and treatment at community cancer programs (aHR = 1.14, 95% CI 1.01, 1.28).

CONCLUSION

Comorbid disease is associated with all-cause sinonasal cancer mortality, and after accounting for known clinical factors, significant differences in mortality persist based on disparity-driven, nonclinical factors.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:1443-1449, 2020.

摘要

目的

描述美国鼻窦癌患者的合并症负担和与全因死亡率相关的非临床因素。

方法

从国家癌症数据库（2004-2013 年）中检索了成人鼻窦癌病例（n=10518）。研究结果为全因死亡率。自变量包括合并症评分和非临床因素，如年龄、性别、种族、医疗机构类型、与医疗机构的距离、保险和收入。通过多变量扩展 Cox 回归和 Heaviside 调整进行生存分析。

结果

患者主要为男性（61%），平均诊断年龄为 63.5 岁。约五分之一的患者（18.7%）在诊断时存在主要合并症（Charlson-Deyo 评分≥1）。在调整临床因素后，合并症评分的增加与死亡率的相应增加相关（合并症评分 1 的调整后危险比[aHR]为 1.25；95%CI，1.16，1.35），（评分 2+的 aHR 为 1.61；95%CI，1.41，1.83）。死亡率的危险也与男性（aHR=1.11；95%CI，1.04，1.17）；黑人（aHR=1.13；95%CI，1.03，1.24）；未参保（aHR=1.45；95%CI，1.25，1.68）或接受医疗补助（aHR=1.50；95%CI，1.33，1.69）；居住在中等收入较低四分位数的邮政编码（aHR<30000=1.17；95%CI，1.06，1.29）；以及在社区癌症项目中接受治疗（aHR=1.14；95%CI 1.01，1.28）有关。