Noncommunicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada, Ibs.GRANADA, University of Granada, Granada, Spain; Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Noncommunicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada, Ibs.GRANADA, University of Granada, Granada, Spain; National School of Public Health, Oswaldo Cruz Foundation, (ENSP, FIOCRUZ), Rio de Janeiro, Brazil.
Eur J Cancer. 2020 Apr;129:4-14. doi: 10.1016/j.ejca.2020.01.021. Epub 2020 Feb 27.
Numerous studies have analysed the effect of comorbidity on cancer outcomes, but evidence on the association between multimorbidity and short-term mortality among colorectal cancer patients is limited. We aimed to assess this association and the most frequent patterns of multimorbidity associated with a higher short-term mortality risk among colorectal cancer patients in Spain.
Data were obtained from two Spanish population-based cancer registries and electronic health records. We estimated the unadjusted cumulative incidence of death by comorbidity status at 6 months and 1 year. We used a flexible parametric model to derive the excess mortality hazard ratios (HRs) for multimorbidity after adjusting for sex, age at diagnosis, cancer stage and treatment. We estimated the adjusted cumulative incidence of death by comorbidity status and identified multimorbidity patterns.
Among the study participants, 1,048 cases were diagnosed with cancers of the colon and rectum, 2 cases with cancer of the anus with overlapping sites of the rectum and 11 cases with anal adenocarcinomas but treated as colorectal cancer patients. Among 1,061 colorectal cancer patients, 171 (16.2%) died before 6 months, 246 (23.3%) died before the 1-year follow-up, and 324 (30.5%) had multimorbidity. Patients with multimorbidity had two times higher mortality risk than those without comorbidities at 6 months (adjusted HR: 2.04; 95% confidence interval [CI]: 1.30-3.20, p = 0.002). The most frequent multimorbidity pattern was congestive heart failure + diabetes. However, patients with rheumatologic disease + diabetes had two times higher 1-year mortality risk than those without comorbidities (HR: 2.23; 95% CI: 1.23-4.07, p = 0.008).
Multimorbidity was a strong independent predictor of short-term mortality at 6 months and 1 year among the colorectal cancer patients in Spain. The identified multimorbidity pattern was consistent. Our findings might help identify patients at a higher risk for poor cancer and treatment outcomes.
大量研究分析了合并症对癌症结局的影响，但有关结直肠癌患者合并症与短期死亡率之间关联的证据有限。本研究旨在评估这种关联，并确定与结直肠癌患者短期死亡率升高相关的最常见合并症模式。
数据来自西班牙两个基于人群的癌症登记处和电子健康记录。我们估计了 6 个月和 1 年时按合并症状态计算的死亡累积发生率。使用灵活的参数模型，在调整了性别、诊断时年龄、癌症分期和治疗后，得出了多重合并症的超额死亡风险比（HR）。我们估计了按合并症状态计算的调整后死亡累积发生率，并确定了合并症模式。
在研究参与者中，有 1048 例被诊断患有结肠癌和直肠癌，2 例为肛门癌，其中 2 例有直肠重叠部位，11 例为肛门腺癌，但作为结直肠癌患者进行治疗。在 1061 例结直肠癌患者中，有 171 例（16.2%）在 6 个月前死亡，246 例（23.3%）在 1 年随访前死亡，324 例（30.5%）患有多种合并症。合并症患者的死亡风险是无合并症患者的两倍，在 6 个月时（调整后的 HR：2.04；95%置信区间[CI]：1.30-3.20，p=0.002）。最常见的合并症模式是充血性心力衰竭+糖尿病。然而，患有风湿性疾病+糖尿病的患者 1 年死亡率是无合并症患者的两倍（HR：2.23；95% CI：1.23-4.07，p=0.008）。
在西班牙的结直肠癌患者中，合并症是 6 个月和 1 年时短期死亡率的一个强有力的独立预测因素。确定的合并症模式是一致的。我们的研究结果可能有助于识别癌症和治疗结局较差风险较高的患者。
