Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland; Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
Cancer Epidemiol. 2021 Aug;73:101962. doi: 10.1016/j.canep.2021.101962. Epub 2021 May 26.
It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data.
We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models.
After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60-2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77-3.34), compared to patients without comorbidities.
Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.
合并症对结直肠癌（CRC）特异性生存有负面影响已得到证实。尽管相对生存（RS）已被证明在考虑死亡证明不准确时特别有用，但只有少数研究使用 RS 来估计这种关联。本研究旨在使用癌症登记数据，调查 CRC 诊断时非癌症合并症对净生存的影响。
我们纳入了苏黎世州 2000 年至 2001 年间诊断的 1076 例 CRC 患者。使用 Charlson 合并症指数（CCI）来表示合并症的数量和严重程度。采用多重插补法处理缺失信息，并通过建模 CRC 导致的超额死亡风险来估计 10 年净生存，使用灵活的参数模型。
插补后，约 35%的患者患有合并症。这些合并症似乎降低了 10 年的净生存率；与无合并症的患者相比，患有 1 种轻度合并症的患者的估计超额危险比为 2.14（95%CI 1.60-2.86），患有 1 种更严重或 1 种以上合并症的患者为 2.43（95%CI 1.77-3.34）。
我们的分析表明，CRC 诊断时的非癌症合并症显著降低了 10 年的净生存率。未来的研究应将包括合并症在内的预后因素纳入 CRC 的净生存率估计，并使用 RS 框架来克服死亡证明的不确定性。
