Gouliaev Anja, Hilberg Ole, Christensen Niels Lyhne, Rasmussen Torben, Ibsen Rikke, Løkke Anders
Department of Pulmonary Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Department of Medicine, Little Belt Hospital, Vejle, Denmark.
Eur Clin Respir J. 2020 Dec 20;8(1):1861579. doi: 10.1080/20018525.2020.1861579.
Lung cancer is the leading cause of cancer-related death worldwide. This population-based longitudinal study investigates survival rates and the burden of comorbidity before and after being diagnosed with lung cancer in Denmark. From the Danish National Patient Registry (NPR) and the Danish Civil Registration System (CPR), 53,749 patients with lung cancer were identified and matched with 214,304 controls on age, gender, region of residence and marital status in the period 1998-2010. From the NPR, data on survival and comorbidity, registered as ICD-10 diagnoses, were extracted. Comorbidity was assessed using the Deyo-Charlson comorbidity score (DCcs) and mortality using Kaplan-Meier survival curves. 1-year survival rate for Danish lung cancer patients was 51.7 % (CI 51.3-52.1) and 5-year survival rate was 14.7 % (CI 14.3-15.0) compared to 96.8 % (CI 96.7-96.8) and 84.0 % (CI 83.9-84.2) for controls respectively. Overall, cases had significantly more comorbidity compared to controls before being diagnosed with lung cancer. Prior to being diagnosed with lung cancer, more cases than controls had been diagnosed with other malignancies (11.4 % vs 6.0 % p<0.005), diseases of the circulatory system (16.4 % vs 13.0 % p<0.005) and respiratory diseases (12.2 % vs 4.8 % p<0.005). Among lung cancer patients 21.8 % had a DCcs ≥ 1 compared to 13.3 % among controls (P<0.005). The 1-year survival for DCcs =0 was 54.8 % (CI 54.3-55.3) for lung cancer patients and 97.8 % (CI 97.7-97.9) for controls. Decreasing survival with increasing DCcs was found in both groups. This study provides unique nationwide comorbidity data on patients before and after being diagnosed with lung cancer. We found increased mortality with increasing comorbidity, however more pronounced among controls compared to patients with lung cancer.
肺癌是全球癌症相关死亡的主要原因。这项基于人群的纵向研究调查了丹麦肺癌患者确诊前后的生存率和合并症负担。从丹麦国家患者登记处（NPR）和丹麦民事登记系统（CPR）中，识别出53749例肺癌患者，并在1998年至2010年期间，将其与214304名对照者按年龄、性别、居住地区和婚姻状况进行匹配。从NPR中提取了以国际疾病分类第十版（ICD - 10）诊断记录的生存和合并症数据。使用Deyo - Charlson合并症评分（DCcs）评估合并症，使用Kaplan - Meier生存曲线评估死亡率。丹麦肺癌患者的1年生存率为51.7%（可信区间51.3 - 52.1），5年生存率为14.7%（可信区间14.3 - 15.0），而对照者的1年生存率为96.8%（可信区间96.7 - 96.8），5年生存率为84.0%（可信区间83.9 - 84.2）。总体而言，肺癌患者在确诊前的合并症显著多于对照者。在被诊断为肺癌之前，被诊断患有其他恶性肿瘤的病例比对照者更多（11.4%对6.0%，p<0.005），循环系统疾病（16.4%对13.0%，p<0.005）和呼吸系统疾病（12.2%对4.8%，p<0.005）。肺癌患者中21.8%的DCcs≥1，而对照者中这一比例为13.3%（P<0.005）。DCcs = 0的肺癌患者1年生存率为54.8%（可信区间54.3 - 55.3），对照者为97.8%（可信区间97.7 - 97.9）。两组均发现随着DCcs增加生存率降低。这项研究提供了肺癌患者确诊前后独特的全国性合并症数据。我们发现随着合并症增加死亡率上升，然而与肺癌患者相比，对照者中更为明显。
