Influence of medical comorbidities on the presentation and outcomes of stage I-III non-small-cell lung cancer

Daniel Ahn, Nishi Mehta, Jeffrey T. Yorio, Yang Xie, Jingsheng Yan, David E. Gerber

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Non-small-cell lung cancer presentation, treatment, and outcomes vary widely according to socioeconomic factors and other patient characteristics. To determine whether medical comorbidities account for these observations, we incorporated a validated medical comorbidity index into an analysis of patients diagnosed with stage I to III NSCLC. Patients and Methods We performed a retrospective analysis of consecutive patients diagnosed with stage I to III NSCLC. Demographic, tumor, and comorbidity data were obtained from hospital tumor registries and individual patient records. The association between variables was assessed using multivariate logistic regression and survival analysis. Results A total of 454 patients met criteria for analysis. The median age was 65 years, and 51% were men. Individuals with a higher Charlson Comorbidity Index (CCI) were significantly more likely to present with early stage (stage I-II) NSCLC than were patients with lower CCI (odds ratio, 1.72; 95% confidence interval, 1.14-2.63; P =.01), although this association lost statistical significance (P =.21) in a multivariate model. In multivariate logistic regression, overall survival remained associated with all variables: age, sex, race, insurance type, stage, histology, and CCI (P =.0007). The CCI was associated with survival for patients with early stage (P =.02) and locally advanced (P =.02) disease. Conclusion In this cohort of patients with stage I to III NSCLC, increasing comorbidity burden had a nonsignificant association with diagnosis at earlier disease stage. Although comorbidity burden was significantly associated with outcome for early stage and locally advanced disease, it did not account for survival differences based on multiple other patient and disease characteristics.

Original languageEnglish (US)
Pages (from-to)644-650
Number of pages7
JournalClinical Lung Cancer
Volume14
Issue number6
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Comorbidity
Survival
Logistic Models
Survival Analysis
Insurance
Registries
Neoplasms
Histology
Odds Ratio
Regression Analysis
Demography
Confidence Intervals

Keywords

  • Charlson Index
  • Disparities
  • Early stage
  • Locally advanced
  • Treatment

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Influence of medical comorbidities on the presentation and outcomes of stage I-III non-small-cell lung cancer. / Ahn, Daniel; Mehta, Nishi; Yorio, Jeffrey T.; Xie, Yang; Yan, Jingsheng; Gerber, David E.

In: Clinical Lung Cancer, Vol. 14, No. 6, 01.11.2013, p. 644-650.

Research output: Contribution to journalArticle

Ahn, Daniel ; Mehta, Nishi ; Yorio, Jeffrey T. ; Xie, Yang ; Yan, Jingsheng ; Gerber, David E. / Influence of medical comorbidities on the presentation and outcomes of stage I-III non-small-cell lung cancer. In: Clinical Lung Cancer. 2013 ; Vol. 14, No. 6. pp. 644-650.
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AU - Gerber, David E.

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N2 - Background Non-small-cell lung cancer presentation, treatment, and outcomes vary widely according to socioeconomic factors and other patient characteristics. To determine whether medical comorbidities account for these observations, we incorporated a validated medical comorbidity index into an analysis of patients diagnosed with stage I to III NSCLC. Patients and Methods We performed a retrospective analysis of consecutive patients diagnosed with stage I to III NSCLC. Demographic, tumor, and comorbidity data were obtained from hospital tumor registries and individual patient records. The association between variables was assessed using multivariate logistic regression and survival analysis. Results A total of 454 patients met criteria for analysis. The median age was 65 years, and 51% were men. Individuals with a higher Charlson Comorbidity Index (CCI) were significantly more likely to present with early stage (stage I-II) NSCLC than were patients with lower CCI (odds ratio, 1.72; 95% confidence interval, 1.14-2.63; P =.01), although this association lost statistical significance (P =.21) in a multivariate model. In multivariate logistic regression, overall survival remained associated with all variables: age, sex, race, insurance type, stage, histology, and CCI (P =.0007). The CCI was associated with survival for patients with early stage (P =.02) and locally advanced (P =.02) disease. Conclusion In this cohort of patients with stage I to III NSCLC, increasing comorbidity burden had a nonsignificant association with diagnosis at earlier disease stage. Although comorbidity burden was significantly associated with outcome for early stage and locally advanced disease, it did not account for survival differences based on multiple other patient and disease characteristics.

AB - Background Non-small-cell lung cancer presentation, treatment, and outcomes vary widely according to socioeconomic factors and other patient characteristics. To determine whether medical comorbidities account for these observations, we incorporated a validated medical comorbidity index into an analysis of patients diagnosed with stage I to III NSCLC. Patients and Methods We performed a retrospective analysis of consecutive patients diagnosed with stage I to III NSCLC. Demographic, tumor, and comorbidity data were obtained from hospital tumor registries and individual patient records. The association between variables was assessed using multivariate logistic regression and survival analysis. Results A total of 454 patients met criteria for analysis. The median age was 65 years, and 51% were men. Individuals with a higher Charlson Comorbidity Index (CCI) were significantly more likely to present with early stage (stage I-II) NSCLC than were patients with lower CCI (odds ratio, 1.72; 95% confidence interval, 1.14-2.63; P =.01), although this association lost statistical significance (P =.21) in a multivariate model. In multivariate logistic regression, overall survival remained associated with all variables: age, sex, race, insurance type, stage, histology, and CCI (P =.0007). The CCI was associated with survival for patients with early stage (P =.02) and locally advanced (P =.02) disease. Conclusion In this cohort of patients with stage I to III NSCLC, increasing comorbidity burden had a nonsignificant association with diagnosis at earlier disease stage. Although comorbidity burden was significantly associated with outcome for early stage and locally advanced disease, it did not account for survival differences based on multiple other patient and disease characteristics.

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