Comorbidities and Charlson score in resected stage I nonsmall cell lung cancer

Abstract

Patients with nonsmall cell lung cancer (NSCLC) have been shown to have a higher prevalence of comorbidity associated with age and tobacco consumption. The objective of the present study was to determine the impact of comorbidity on survival after surgery of stage I NSCLC.In total, 588 consecutive patients operated on for a pathological stage I NSCLC between January 1, 1979 and December 31, 2003 were studied. Comorbidities were analysed individually. Overall comorbidity was assessed using the Charlson index of comorbidity (CCI). Survival data were collected for each patient from the date of operation, with a median duration of follow-up of 104 months. Survival analyses and Cox proportional hazards model analyses were used.The mean age of patients was 62.7 yrs, and 529 (89%) patients were male. The distribution of overall comorbidity severity was as follows. CCI grade 0: 47.1%; grade 1-2: 43.7%; grade 3-4: 8.3%; and grade o5: 0.8%.The 2, 3 and 5 yrs survival were 69, 62 and 50%, respectively. Multivariable analysis showed that T stage, age, a concomitant history of moderate-to-severe liver disease, a past history of cured cancer, cerebrovascular disease and CCI were independent predictors of survival (Hazard Ratio for CCI grade .2: 1.81; 95% confidence interval 1.25-2.63).In conclusion, comorbidity has a significant impact on survival after surgical resection of patients with stage I nonsmall cell lung cancer. The use of a validated index of comorbidity in prognostic analyses of resected nonsmall cell lung cancer is recommended.

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

“…[3][4][5][6] Besides aging, comorbidities such as COPD, diabetes mellitus, hypertension, peripheral artery disease, and heart failure are highly prevalent in these patients and may all limit aerobic exercise capacity. 7 Moreover, sedentary behavior and the inflammatory component associated with cancer contribute to muscle wasting and decreased peripheral aerobic metabolic capacity. Finally, there can be deleterious effects of surgery, radiotherapy, and chemotherapy.…”

Impact of Accompanying Comorbidities on Survival in Patients with Stage IIIB- IV Non-Small-Cell Lung Cancer

“…In a study conducted by D. MoroSibilotand et al, 588 patients with stage I and stage II NSCLC were examined, and the most common comorbid factors were as follows: chronic lung disease (15.3%), peripheral venous disease (13.4%), coronary heart disease (12.7%), peptic ulcers (10.7%), and diabetes mellitus (6.3%). 14 In a series of report analyses done by Janssen-Heijnen et al in which 3864 lung carcinoma patient reports from the extensive population registry of the Eindhoven Cancer Center were reviewed, the most common comorbidities accompanying lung cancer in patients were found to be cardiovascular diseases (23%) and chronic obstructive lung diseases (22%), with other type of cancers making up the remainder (15%). 5 In another study, Birim et al evaluated 205 NSCLC patients, with 97% of those having been diagnosed as stage 1, and found the most common accompanying comorbidity factors to be chronic lung disease (37.1%), peripheral vascular disease (25.9%), and coronary heart disease (22.9%).…”

“…14,[25][26][27] In one such study by Wang et al conducted on NSCLC stage 1 patients who were followed up for five years following surgery, those with scores of 2 or higher in the CCI were found to have higher five-year survival rates than the patients with scores lower than 2. 25 In another study conducted by D. Moro-Sibilot et al, patients were evaluated by means of the CCI, and it was reported that survival duration was shorter in patients with higher Charlson scores.…”

“…25 In another study conducted by D. Moro-Sibilot et al, patients were evaluated by means of the CCI, and it was reported that survival duration was shorter in patients with higher Charlson scores. 14 In the study by Fırat et al which included stage IIIA and IIIB NSCLC patients and which accepted comorbidity and the Karnofsky Performance Status (KPS) scale as prognostic factors, it was shown that the (KPS) and comorbidity scores affected survival durations. 26 In the study by Birim et al, 433 NSCLC patients, 98% of whom had stage IA -IIIA disease, were assessed by means of the CCI and were divided into four groups by their CCI scores (0, 1-2, 3-4, and ≥ 5).…”

Physician and Hospital Characteristics Related to Length of Stay for Acute Myocardial Infarction Patients A 3-Year Population-Based Analysis

“…15,16 Risk factors were scaled in accordance with the CCI, ranging from prior myocardial infarction or congestive heart failure (each with a weight of 1) to AIDS or a solid metastatic tumor (each with a weight of 6).…”