Morishima Toshitaka, Sato Akira, Nakata Kayo, Matsumoto Yoshifumi, Koeda Nobuyuki, Shimada Hiroko, Maruhama Tsutomu, Matsuki Daisaku, Miyashiro Isao
Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
BMJ Open. 2021 Apr 14;11(4):e046681. doi: 10.1136/bmjopen-2020-046681.
Functional status assessments of activities of daily living may improve prognostic precision during initial diagnostic evaluations in young and middle-aged adults with cancer. However, the association between pretreatment functional status and survival in these patients is poorly understood. This study aimed to evaluate the prognostic value of functional status in young and middle-aged patients with cancer.
Multicentre retrospective cohort study.
We used a cancer registry from Osaka Prefecture, Japan. The data were linked to administrative claims data from 35 hospitals in the same prefecture.
Patients aged 18-69 years who received new diagnoses of gastric, colorectal or lung cancer between 2010 and 2014.
Cox proportional hazards models of 5-year all-cause mortality were developed to examine the prognostic impact of pretreatment functional status, which was categorised into three levels of functional disability (none, moderate and severe) based on Barthel Index scores. The models controlled for age, sex, comorbidities, cancer stage and tumour histology.
We analysed 12 134 patients. Higher mortality risks were significantly associated with moderate functional disability (adjusted HR 1.44 (95% CI 1.18 to 1.75), 1.35 (95% CI 1.08 to 1.68) and 1.74 (95% CI 1.50 to 2.03) in patients with gastric, colorectal and lung cancer, respectively) and severe functional disability (adjusted HR 3.56 (95% CI 2.81 to 4.51), 2.37 (95% CI 1.89 to 2.95) and 2.34 (95% CI 2.00 to 2.75) in patients with gastric, colorectal and lung cancer, respectively).
Accounting for functional status at cancer diagnosis may improve the prediction of survival time in young and middle-aged adults with cancer. Functional status has potential applications in survival predictions and risk adjustments when analysing outcomes in patients with cancer.
对日常生活活动进行功能状态评估，可能会提高年轻及中年癌症患者初始诊断评估期间的预后预测准确性。然而，这些患者治疗前功能状态与生存之间的关联尚不清楚。本研究旨在评估功能状态对年轻及中年癌症患者的预后价值。
多中心回顾性队列研究。
我们使用了日本大阪府的癌症登记处。数据与同一府内35家医院的行政索赔数据相关联。
2010年至2014年间新诊断为胃癌、结直肠癌或肺癌的18 - 69岁患者。
建立5年全因死亡率的Cox比例风险模型，以检验治疗前功能状态的预后影响，根据巴氏指数评分将其分为三个功能残疾水平（无、中度和重度）。模型对年龄、性别、合并症、癌症分期和肿瘤组织学进行了控制。
我们分析了12134例患者。胃癌、结直肠癌和肺癌患者中，中度功能残疾分别与较高的死亡风险显著相关（调整后风险比分别为1.44（95%置信区间1.18至1.75）、1.35（95%置信区间1.08至1.68）和1.74（95%置信区间1.50至2.03）），重度功能残疾分别与较高的死亡风险显著相关（调整后风险比分别为3.56（95%置信区间2.81至4.51）、2.37（95%置信区间1.89至2.95）和2.34（95%置信区间2.00至2.75））。
在癌症诊断时考虑功能状态可能会改善年轻及中年癌症患者生存时间的预测。在分析癌症患者的预后时，功能状态在生存预测和风险调整方面具有潜在应用价值。
