Lu Ming-Shian, Lu Hung-I, Chen Tzu-Ping, Chang Che-Chia, Yang Tsung-Ming, Chen Miao-Fen
Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan.
Division of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
Cancer Manag Res. 2021 Jun 1;13:4373-4381. doi: 10.2147/CMAR.S304980. eCollection 2021.
The survival outcome of lung cancer patients with coexisting liver cirrhosis has thus far received limited attention in the literature. In this study, we evaluated whether liver cirrhosis is an independent risk factor for the survival of patients with lung cancer.
We conducted a retrospective, multicenter, propensity-matched study of lung cancer patients with and without liver cirrhosis. To determine differences in survival, we sought to identify risk factors associated with poor outcomes using Kaplan-Meier survival analysis and Cox proportional hazards regression.
There were no statistically significant differences in the baseline clinical characteristics of patients between the cirrhosis and non-cirrhosis groups. The median overall survival of patients with and without cirrhosis was 13.07 months (95% confidence interval [CI]: 10.56-16.84) and 13.67 months (95% CI: 10.42-16.91), respectively (p=0.76). Cox proportional hazards regression analysis revealed that liver cirrhosis was not an independent risk factor for poor outcome (hazard ratio [HR]: 1.057, 95% CI: 0.805-1.388, p=0.690). In patients with cirrhosis, lower serum albumin levels, higher Charlson Comorbidity Index score, advanced-stage lung cancer, and treatment modality were factors associated with poor outcome. Increase in serum albumin by 1 g was associated with a 30% reduction in the risk of mortality (HR: 0.700, 95% CI: 0.494-0.993, p=0.045). While every point increase in the Charlson Comorbidity Index score by 1 point was linked to a 9% higher risk of mortality (HR: 1.090, 95% CI: 1.023-1.161, p=0.007).
The survival rates of lung cancer patients with and without cirrhosis did not differ significantly. Higher serum albumin levels and lower Charlson Comorbidity Index scores were associated with improved survival.
肺癌合并肝硬化患者的生存结局在文献中迄今受到的关注有限。在本研究中，我们评估了肝硬化是否是肺癌患者生存的独立危险因素。
我们对有和没有肝硬化的肺癌患者进行了一项回顾性、多中心、倾向评分匹配研究。为了确定生存差异，我们试图使用Kaplan-Meier生存分析和Cox比例风险回归来识别与不良结局相关的危险因素。
肝硬化组和非肝硬化组患者的基线临床特征无统计学显著差异。有和没有肝硬化的患者的中位总生存期分别为13.07个月（95%置信区间[CI]：10.56-16.84）和13.67个月（95%CI：10.42-16.91）（p=0.76）。Cox比例风险回归分析显示，肝硬化不是不良结局的独立危险因素（风险比[HR]：1.057，95%CI：0.805-1.388，p=0.690）。在肝硬化患者中，较低的血清白蛋白水平、较高的Charlson合并症指数评分、晚期肺癌和治疗方式是与不良结局相关的因素。血清白蛋白每增加1g，死亡风险降低30%（HR：0.700，95%CI：0.494-0.993，p=0.045）。而Charlson合并症指数评分每增加1分，死亡风险就会增加9%（HR：1.090，95%CI：1.023-1.161，p=0.007）。
有和没有肝硬化的肺癌患者的生存率没有显著差异。较高的血清白蛋白水平和较低的Charlson合并症指数评分与生存改善相关。
