Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Oncol Res. 2023 Jan 31;30(4):173-185. doi: 10.32604/or.2022.027262. eCollection 2022.
Lung cancer is the most common cancer type worldwide and has the highest and second highest mortality rate for men and women respectively in Germany. Yet, the role of comorbid illnesses in lung cancer patient prognosis is still debated. We analyzed administrative claims data from one of the largest statutory health insurance (SHI) funds in Germany, covering close to 9 million people (11% of the national population); observation period was from 2005 to 2019. Lung cancer patients and their concomitant diseases were identified by ICD-10-GM codes. Comorbidities were classified according to the Charlson Comorbidity Index (CCI). Incidence, comorbidity prevalence and survival are estimated considering sex, age at diagnosis, and place of residence. Kaplan Meier curves with 95% confidence intervals were built in relation to common comorbidities. We identified 70,698 lung cancer incident cases in the sample. Incidence and survival figures are comparable to official statistics in Germany. Most prevalent comorbidities are chronic obstructive pulmonary disease (COPD) (36.7%), followed by peripheral vascular disease (PVD) (18.7%), diabetes without chronic complications (17.4%), congestive heart failure (CHF) (16.5%) and renal disease (14.7%). Relative to overall survival, lung cancer patients with CHF, cerebrovascular disease (CEVD) and renal disease are associated with largest drops in survival probabilities (9% or higher), while those with PVD and diabetes without chronic complications with moderate drops (7% or lower). The study showed a negative association between survival and most common comorbidities among lung cancer patients, based on a large sample for Germany. Further research needs to explore the individual effect of comorbidities disentangled from that of other patient characteristics such as cancer stage and histology.
肺癌是全球最常见的癌症类型,在德国,男性和女性的肺癌死亡率分别位居第一和第二。然而,合并症在肺癌患者预后中的作用仍存在争议。我们分析了德国最大的法定健康保险(SHI)基金之一的管理索赔数据,该数据覆盖了近 900 万人(占全国人口的 11%);观察期为 2005 年至 2019 年。通过 ICD-10-GM 代码确定肺癌患者及其伴随疾病。根据 Charlson 合并症指数(CCI)对合并症进行分类。考虑到性别、诊断时的年龄和居住地,估计发病率、合并症患病率和生存率。与常见合并症相关的 Kaplan-Meier 曲线及其 95%置信区间。我们在样本中确定了 70698 例肺癌新发病例。发病率和生存率数据与德国官方统计数据相当。最常见的合并症是慢性阻塞性肺疾病(COPD)(36.7%),其次是外周血管疾病(PVD)(18.7%)、无慢性并发症的糖尿病(17.4%)、充血性心力衰竭(CHF)(16.5%)和肾脏疾病(14.7%)。与总体生存率相比,患有 CHF、脑血管疾病(CEVD)和肾脏疾病的肺癌患者的生存率下降幅度最大(9%或更高),而患有 PVD 和无慢性并发症的糖尿病患者的生存率下降幅度适中(7%或更低)。该研究基于德国的大样本,表明了生存与肺癌患者最常见合并症之间的负相关关系。需要进一步研究以探讨合并症对患者特征(如癌症分期和组织学)的影响。
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