Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Carrer del Sol 15, 17004 Girona, Spain.
Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, C/Universitat de Girona 10, 17003 Girona, Spain.
Int J Environ Res Public Health. 2021 Jan 15;18(2):701. doi: 10.3390/ijerph18020701.
This study aimed to examine the prevalence of comorbidities in patients diagnosed with chronic lymphocytic leukemia (CLL), and to assess its influence on survival and cause-specific mortality at a population-based level. Incident CLL cases diagnosed in the Girona province (Spain) during 2008-2016 were extracted from the Girona Cancer Registry. Rai stage and presence of comorbidities at diagnosis, further categorized using the Charlson comorbidity index (CCI), were obtained from clinical records. Observed (OS) and relative survival (RS) were estimated and Cox's proportional hazard models were used to explore the impact of comorbidity on mortality. Among the 400 cases included in the study, 380 (99.5%) presented at least one comorbidity at CLL diagnosis, with diabetes without end organ damage (21%) being the most common disease. 5-year OS and RS were 68.8 (95% CI: 64.4-73.6) and 99.5 (95% CI 3.13-106.0), respectively, which decreased markedly with increasing CCI, particularly in patients with CCI ≥ 3. Multivariate analysis identified no statistically significant association between the CCI and overall CLL-related or CLL-unrelated mortality. In conclusion, a high CCI score negatively influenced the OS and RS of CLL patients, yet its effect on mortality was statistically non-significant when also considering age and the Rai stage.
本研究旨在调查慢性淋巴细胞白血病（CLL）患者合并症的流行情况，并评估其在基于人群的水平上对生存和特定原因死亡率的影响。2008-2016 年在西班牙赫罗纳省诊断的 CLL 病例从赫罗纳癌症登记处提取。从临床记录中获得诊断时的 Rai 分期和合并症（进一步使用 Charlson 合并症指数（CCI）分类）。观察（OS）和相对生存（RS）进行估计，并使用 Cox 比例风险模型探讨合并症对死亡率的影响。在研究中纳入的 400 例病例中，380 例（99.5%）在 CLL 诊断时至少有一种合并症，最常见的疾病是无终末器官损害的糖尿病（21%）。5 年 OS 和 RS 分别为 68.8（95%CI：64.4-73.6）和 99.5（95%CI 3.13-106.0），随着 CCI 的增加而显著下降，特别是 CCI≥3 的患者。多变量分析未发现 CCI 与总体 CLL 相关或 CLL 无关的死亡率之间存在统计学显著关联。总之，CCI 评分高对 CLL 患者的 OS 和 RS 产生负面影响，但在考虑年龄和 Rai 分期时，其对死亡率的影响无统计学意义。
