Qu Wei-Feng, Zhou Pei-Yun, Liu Wei-Ren, Tian Meng-Xin, Jin Lei, Jiang Xi-Fei, Wang Han, Tao Chen-Yang, Fang Yuan, Zhou Yu-Fu, Song Shu-Shu, Ding Zhen-Bin, Peng Yuan-Fei, Dai Zhi, Qiu Shuang-Jian, Zhou Jian, Fan Jia, Tang Zheng, Shi Ying-Hong
Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai 200032, China.
Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.
Ann Transl Med. 2020 Apr;8(7):487. doi: 10.21037/atm.2020.03.23.
Comorbidity among cancer patients is prevalent and influential to prognosis after operation. Limited data are available on comorbidity evaluations in patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to assess the comorbidity distribution in ICC patients and to adapt the Charlson Comorbidity Index (CCI) or the age-adjusted CCI (ACCI) for survival prediction.
The study cohort included 268 ICC patients treated with curative surgery from January 2000 to December 2007 at the Department of Liver Surgery, Zhongshan Hospital. The association between the comorbidity index and overall survival (OS) or disease-free survival (DFS). was analyzed by the Kaplan-Meier method. Multivariable analysis was established to select the determinant parameters.
Major comorbid conditions of ICC patients included liver disease, hypertension, diabetes and ulcer. The median follow-up time was 25.5 months in the whole data set. Among the entire cohort, the 1-, 3- and 5-year OS rates were 55.3%, 26.0% and 15.6%, respectively. In multivariate analysis, the ACCI correlated with OS, and higher scores were associated with poorer prognosis (hazard ratio =1.134, 95% confidence interval: 1.015-1.267 and P value =0.026). CCI was not an independent predictive factor for OS or DFS.
In contrast to CCI, ACCI was a more promising model to accurately predict OS in ICC patients who underwent liver resection. Further research should be focused on the impact of comorbidity therapies.
癌症患者的合并症很常见，且对术后预后有影响。关于肝内胆管癌（ICC）患者合并症评估的数据有限。本研究旨在评估ICC患者的合并症分布情况，并采用Charlson合并症指数（CCI）或年龄校正CCI（ACCI）进行生存预测。
研究队列包括2000年1月至2007年12月在中山医院肝脏外科接受根治性手术的268例ICC患者。采用Kaplan-Meier法分析合并症指数与总生存（OS）或无病生存（DFS）之间的关联。建立多变量分析以选择决定因素参数。
ICC患者的主要合并症包括肝脏疾病、高血压、糖尿病和溃疡。整个数据集的中位随访时间为25.5个月。在整个队列中，1年、3年和5年的OS率分别为55.3%、26.0%和15.6%。在多变量分析中，ACCI与OS相关，得分越高预后越差（风险比=1.134，95%置信区间：1.015-1.267，P值=0.026）。CCI不是OS或DFS的独立预测因素。
与CCI相比，ACCI是一种更有前景的模型，可准确预测接受肝切除的ICC患者的OS。进一步的研究应集中在合并症治疗的影响上。
