Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
Acta Oncol. 2020 Aug;59(8):994-1001. doi: 10.1080/0284186X.2020.1764096. Epub 2020 May 28.
Comorbidity is an important prognostic marker and a treatment indicator for lung cancer patients. Register-based studies often describe the burden of comorbidity by the Charlson comorbidity index (CCI) based on hospital discharge data. We assessed the association between somatic and psychiatric comorbidity and death within one year in early lung cancer and, furthermore, the burden of comorbidity according to treatment type. We conducted a population-based matched case-control study of stage I lung cancer identifying all treated patients who died (all-cause) within one year after diagnosis (early death group, cases). On the basis of data from the Danish Lung Cancer Registry these patients were then matched with two controls who survived more than one year (survivors). Through a review of the medical records, we validated inclusion criteria and collected data on somatic and psychiatric comorbidity. We assessed the association between comorbidity and early death with multivariate conditional logistic regression. We included 221 cases and 410 controls. The mean CCI score in the early death group was 2.3 vs. 1.3 in the survivor group ( < .001). Still, 22% vs. 30% had a CCI score of zero ( = .04) with an average number of comorbidities among these patients of 1.63 vs. 1.06 respectively ( = .006). Among women, 23% in the early death group had depression vs. 13% in the survivor group, corresponding to an unadjusted odds ratio (OR) of 2.0 (CI 95% 1.0-3.7). However, in an adjusted analysis (incl. somatic comorbidities) the OR was 1.7 (CI 95% 0.8-3.5). Patients undergoing oncological therapy were older and tended to have more somatic comorbidities than the surgically treated patients. Comorbidity remains a significant prognostic marker even for stage I lung cancer patients with a CCI score of zero. The suggested association between early death and depression among women needs to be studied further.
合并症是肺癌患者的重要预后标志物和治疗指标。基于登记的研究通常使用基于医院出院数据的 Charlson 合并症指数 (CCI) 来描述合并症负担。我们评估了躯体和精神合并症与早期肺癌一年内死亡之间的关系，并进一步根据治疗类型评估了合并症负担。我们进行了一项基于人群的Ⅰ期肺癌病例对照研究，确定了所有在诊断后一年内（早期死亡组，病例）因任何原因死亡的治疗患者。在此基础上，根据丹麦肺癌登记处的数据，这些患者与两名存活超过一年的对照者（幸存者）进行匹配。通过审查病历，我们验证了纳入标准并收集了躯体和精神合并症的数据。我们使用多变量条件逻辑回归评估了合并症与早期死亡之间的关系。我们纳入了 221 例病例和 410 例对照。早期死亡组的平均 CCI 评分为 2.3，而幸存者组为 1.3（ < .001）。尽管如此，仍有 22%的患者 CCI 评分为 0，而幸存者组有 30%（ = .04），这些患者的平均合并症数分别为 1.63 和 1.06（ = .006）。在女性中，早期死亡组中有 23%患有抑郁症，而幸存者组中有 13%，未调整的比值比（OR）为 2.0（95%CI 1.0-3.7）。然而，在调整分析（包括躯体合并症）中，OR 为 1.7（95%CI 95% 0.8-3.5）。接受肿瘤治疗的患者年龄较大，且躯体合并症多于接受手术治疗的患者。即使 CCI 评分为 0 的Ⅰ期肺癌患者，合并症仍然是一个重要的预后标志物。需要进一步研究女性早期死亡与抑郁之间的关联。
