The effect of comorbidity on stage-specific survival in resected non-small celllung cancer patients


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M. Lüchtenborg1,2, E. Jakobsen3,4, M. Krasnik5, K. Linklater1,2, A. Mellemgaard5, H. Møller1,2
1King's College London, London, UK, 2Thames Cancer Registry, London, UK, 3The Danish Lung Cancer Registry, Denmark, Denmark, 4Odense University Hospital 'Rigshospitalet', Odense, Denmark, 5Copenhagen University Hospital at Herlev, Herlev, Denmark

Background

Severe comorbidity affects overall survival, and may be an independent prognostic factor in lung cancer. We quantified the effect of comorbidity on stage-specific survival in resected non-small cell lung cancer (NSCLC) patients in a large populationbased setting.

Method

Among 3,152 NSCLC patients diagnosed between 1st January 2005 and 31st December 2010 and identified from the Danish Lung Cancer Registry who underwent surgical resection, mortality hazard ratios were calculated during three time periods following surgery (0-1 month, 1 month - 1 year and >1 year) according to Charlson comorbidity score (CCS 0, 1-2, 3+), ECOGperformance status, lung function, age, sex, pathological T (pT) and N (pN) stage using Cox proportional hazard modelling. The Kaplan Meier method was used to describe stage-specific survival according to CCS.

Results

Increasing severity of comorbidity was independently associated with significantly higher death rates throughout the three periods of follow-up [HR1.18 (95% confidence interval (CI) 0.71-1,97) for CCS 1-2 and 2.06 (1.13-3.75) for CCS 3+ in 0-1 month, 1.13 (0.90-1.42) for CCS 1-2 and 1.57 (1.17-2.12) for CCS 3+ during 1 month - 1 year and 1.14 (0.95-1.36) for CCS 1-2 and 1.84 (1.42-2.37) for CCS 3+ after 1 year]. Stage-specific five-year survival in patients with severe comorbidity (CCS 3+) was significantly lower than in patients without comorbid disease [e.g., 38% (95% CI 23-53%) for pT1 & CCS 3+ vs. 69% (62-75%) for pT1 & CCS 0].

Conclusion

Severe comorbidity affects survival of NSCLC patients who undergo surgical resection by as much as a single stage increment and this effect persist throughout follow-up.