Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2023 Aug;30(8):4617-4626. doi: 10.1245/s10434-023-13596-z. Epub 2023 May 19.
While patients with multiple comorbidities may have frequent contact with medical providers, it is unclear whether their healthcare visits translate into earlier detection of cancers, specifically breast and colon cancers.
Patients diagnosed with stage I-IV breast ductal carcinoma and colon adenocarcinoma were identified from the National Cancer Database and stratified by comorbidity burden, dichotomized as a Charlson Comorbidity Index (CCI) Score of <2 or ≥2. Characteristics associated with comorbidities were analyzed by univariate and multivariate logistic regression. Propensity-score matching was performed to determine the impact of CCI on stage at cancer diagnosis, dichotomized as early (I-II) or late (III-IV).
A total of 672,032 patients with colon adenocarcinoma and 2,132,889 with breast ductal carcinoma were included. Patients with colon adenocarcinoma who had a CCI ≥ 2 (11%, n = 72,620) were more likely to be diagnosed with early-stage disease (53% vs. 47%; odds ratio [OR] 1.02, p = 0.017), and this finding persisted after propensity matching (CCI ≥ 2 55% vs. CCI < 2 53%, p < 0.001). Patients with breast ductal carcinoma who had a CCI ≥ 2 (4%, n = 85,069) were more likely to be diagnosed with late-stage disease (15% vs. 12%; OR 1.35, p < 0.001). This finding also persisted after propensity matching (CCI ≥ 2 14% vs. CCI < 2 10%, p < 0.001).
Patients with more comorbidities are more likely to present with early-stage colon cancers but late-stage breast cancers. This finding may reflect differences in practice patterns for routine screening in these patients. Providers should continue guideline directed screenings to detect cancers at an earlier stage and optimize outcomes.
尽管患有多种合并症的患者可能会频繁接触医疗服务提供者，但尚不清楚他们的医疗就诊是否能更早地发现癌症，特别是乳腺癌和结肠癌。
从国家癌症数据库中确定了患有 I-IV 期乳腺导管癌和结肠腺癌的患者，并按合并症负担进行分层，分为 Charlson 合并症指数（CCI）评分<2 或≥2。通过单变量和多变量逻辑回归分析与合并症相关的特征。进行倾向评分匹配以确定 CCI 对癌症诊断时的分期的影响，分为早期（I-II 期）或晚期（III-IV 期）。
共纳入 672032 例结肠腺癌患者和 2132889 例乳腺导管癌患者。CCI≥2（11%，n=72620）的结肠腺癌患者更有可能被诊断为早期疾病（53% vs. 47%；比值比[OR]1.02，p=0.017），且这一发现在倾向评分匹配后仍然存在（CCI≥2 为 55%，CCI<2 为 53%，p<0.001）。CCI≥2（4%，n=85069）的乳腺导管癌患者更有可能被诊断为晚期疾病（15% vs. 12%；OR 1.35，p<0.001）。这一发现在倾向评分匹配后仍然存在（CCI≥2 为 14%，CCI<2 为 10%，p<0.001）。
合并症较多的患者更有可能患有早期结肠癌和晚期乳腺癌。这一发现可能反映了这些患者常规筛查实践模式的差异。医疗服务提供者应继续进行指南指导的筛查，以更早地发现癌症并优化治疗效果。
