West D W, Satariano W A, Ragland D R, Hiatt R A
Northern California Cancer Center, Union City 94587, USA.
Ann Epidemiol. 1996 Sep;6(5):413-9. doi: 10.1016/s1047-2797(96)00096-8.
The presence of concurrent health conditions (comorbidity) at the time of breast cancer diagnosis has an adverse effect on survival. It is unclear, however, whether the strength of the association between comorbidity and survival varies in different populations of breast cancer patients. It is necessary, therefore, to establish (1) whether a comorbidity index derived from a general population of patients (mostly white) would predict survival in a black population, and (2) whether comorbidity would have the same degree of relationship to mortality in black as in white populations. We studied 1196 breast cancer patients who were members of the Kaiser Permanente Medical Care Program and were diagnosed with local (n = 708), regional (n = 446), or remote (n = 49) stage breast cancer from 1973 to 1986. Mortality follow-up was completed to December 1994. Ten-year survival was studied in relation to the Charlson comorbidity index for black women and for white women, and for both groups of women combined. Compared to women with a Charlson comorbidity score of 0 (no comorbidity), patients with scores of 1, 2, and 3+ had risk ratios for ten-year mortality of 1.23 (P = 0.10), 2.58 (P < 0.001), and 3.44 (P < 0.001), respectively. This pattern of risk associated with comorbidity was similar to that found in the original Charlson study. The pattern of risk ratios for different levels of comorbidity was very similar for black and white patients. The results confirm previous studies indicating that comorbidity (in particular, the Charlson Comorbidity Index) predicts the survival of women with breast cancer, independently of other factors, such as stage of breast cancer at diagnosis. The Charlson index has prognostic significance for both black and white populations. Research is needed to determine whether the Charlson index can be improved by including health conditions that are particularly prevalent or severe in specific subgroups of women.
乳腺癌诊断时并存的健康状况（合并症）对生存有不利影响。然而，合并症与生存之间关联的强度在不同乳腺癌患者群体中是否存在差异尚不清楚。因此，有必要确定：（1）源自普通患者群体（大多为白人）的合并症指数能否预测黑人患者群体的生存情况；（2）合并症与黑人患者死亡率的关系是否与白人患者相同。我们研究了1196名乳腺癌患者，这些患者均为凯撒医疗保健计划的成员，于1973年至1986年被诊断为局部（n = 708）、区域（n = 446）或远处（n = 49）期乳腺癌。死亡率随访至1994年12月。研究了黑人女性、白人女性以及两组女性合并后的十年生存率与查尔森合并症指数的关系。与查尔森合并症评分为0（无合并症）的女性相比，评分为1、2和3+的患者十年死亡率的风险比分别为1.23（P = 0.10）、2.58（P < 0.001）和3.44（P < 0.001）。这种与合并症相关的风险模式与原始查尔森研究中发现的模式相似。不同合并症水平的风险比模式在黑人和白人患者中非常相似。结果证实了先前的研究，表明合并症（特别是查尔森合并症指数）可独立于其他因素（如诊断时乳腺癌的分期）预测乳腺癌女性的生存情况。查尔森指数对黑人和白人人群均具有预后意义。需要开展研究以确定是否可以通过纳入特定女性亚组中特别普遍或严重的健康状况来改进查尔森指数。
