Ching-Chieh Yang1,2,3, Yao Fong4, Li-Ching Lin1, Jenny Que1, Wei-Chen Ting1, Chia-Li Chang5, Hsin-Min Wu5, Chung-Han Ho5,6, Jhi-Joung Wang5, Chung-I Huang7. 1. Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan. 2. Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. 3. Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan. 4. Department of Thoracic Surgery, Chi-Mei Medical Center, Tainan, Taiwan. 5. Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. 6. Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan. 7. Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
Abstract
OBJECTIVES: To compare the prognostic performance between different comorbidity assessments of survival in patients with operated lung cancer. METHODS: A total of 4508 lung cancer patients treated by surgery between 2003 and 2012 were identified through Taiwan's National Health Insurance Research Database. Information on pre-existing comorbidities prior to the cancer diagnosis was obtained and adapted to the Charlson comorbidity index, age-adjusted Charlson comorbidity index (ACCI) and Elixhauser comorbidity index scores. The influence on survival was analysed using a Cox proportional hazard model. The discriminatory ability of the comorbidity indices were evaluated using Akaike information criterion and Harrell's C-statistic. RESULTS: The mean age of the study cohort was 64.95 ± 11.15 years, and 56.28% of the patients were male. The median follow-up time was 2.59 years, and the 3-year overall survival was 73.94%. Among these patients, 2134 (47.3%) patients received adjuvant therapy. The Charlson comorbidity index and ACCI scores correlated well with survival and higher scores were associated with an increased 3-year mortality risk (hazard ratio = 1.21, 95% confidence interval = 1.03-1.42 and hazard ratio = 1.43, 95% confidence interval = 1.08-1.90, respectively) in multivariate analysis. The ACCI scores provided better discriminatory ability with a smaller Akaike information criterion and greater Harrell's C-statistic for 3-year overall survival compared to the Charlson comorbidity index or Elixhauser comorbidity index scores. CONCLUSIONS: The operated lung cancer patients with severe comorbidities were associated with worse survival. The ACCI appears to be a more appropriate prognostic indicator and should be considered for use in clinical practice.
OBJECTIVES: To compare the prognostic performance between different comorbidity assessments of survival in patients with operated lung cancer. METHODS: A total of 4508 lung cancerpatients treated by surgery between 2003 and 2012 were identified through Taiwan's National Health Insurance Research Database. Information on pre-existing comorbidities prior to the cancer diagnosis was obtained and adapted to the Charlson comorbidity index, age-adjusted Charlson comorbidity index (ACCI) and Elixhauser comorbidity index scores. The influence on survival was analysed using a Cox proportional hazard model. The discriminatory ability of the comorbidity indices were evaluated using Akaike information criterion and Harrell's C-statistic. RESULTS: The mean age of the study cohort was 64.95 ± 11.15 years, and 56.28% of the patients were male. The median follow-up time was 2.59 years, and the 3-year overall survival was 73.94%. Among these patients, 2134 (47.3%) patients received adjuvant therapy. The Charlson comorbidity index and ACCI scores correlated well with survival and higher scores were associated with an increased 3-year mortality risk (hazard ratio = 1.21, 95% confidence interval = 1.03-1.42 and hazard ratio = 1.43, 95% confidence interval = 1.08-1.90, respectively) in multivariate analysis. The ACCI scores provided better discriminatory ability with a smaller Akaike information criterion and greater Harrell's C-statistic for 3-year overall survival compared to the Charlson comorbidity index or Elixhauser comorbidity index scores. CONCLUSIONS: The operated lung cancerpatients with severe comorbidities were associated with worse survival. The ACCI appears to be a more appropriate prognostic indicator and should be considered for use in clinical practice.
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