Abstract
Aim
To quantify the effect of comorbidity on stage-specific survival in resected non-small
cell lung cancer (NSCLC) patients.
Methods
From the Danish Lung Cancer Registry, 20,461 patients diagnosed with lung cancer between
1st January 2005 and 31st December 2010 were identified. Among 3152 NSCLC patients
who underwent surgical resection, mortality hazard ratios were calculated during three
consecutive time periods following surgery (0–1 month, 1 month–1 year and >1 year) according to Charlson comorbidity score (CCS 0, 1, 2, 3+), Eastern Cooperative
Oncology Group (ECOG) performance 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 the CCS.
Results
Severe comorbidity (CCS 3+) was independently associated with significantly higher
death rates throughout the three periods of follow-up [Hazard ratio (HR) 2.06 (1.13–3.75)
for CCS 3+ in 0–1 month, 1.57 (1.17–2.12) 3+ during1 month–1 year and 1.84 (1.42–2.37) after 1 year]. Stage-specific 5-year survival in patients with severe comorbidity was significantly
lower than in patients without comorbid disease [e.g. 38% (95% confidence interval
(CI) 23–53%) for pT1 and CCS 3+ versus 69% (62–75%) for pT1 and 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 persists throughout follow-up.
Further research may be necessary to help identify which patients are most likely
to benefit from surgery.
Keywords
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Article info
Publication history
Published online: July 16, 2012
Identification
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© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
