The role of comorbidity in the management and prognosis in nonsmall cell lung cancer: a population-based study

Figures & data

Figure 1. Cumulative- and cause-specific survival by Charlson comorbidity index (CCI).

Figure 2. Cumulative probability of death by lung cancer or other causes by Charlson comorbidity index (CCI).

Table 1. Charlon comorbidity index (CCI) and medical conditions within CCI among patients diagnosed with NSCLC and lung cancer-free controls.

	Cases	%	Controls	%	p value
Charlson Comorbidity Index (CCI)
CCI 0	13,756	55.7	128,759	69.6	–
CCI 1–2	8011	32.4	42,902	23.2	–
CCI 3+	2936	11.9	13,294	7.2	<.001
Medical condition
Myocardial infarction	2006	8.1	11,427	6.2	<.001
Congestive heart failure	1719	7.0	9446	5.1	<.001
Peripheral vascular disease	1409	5.7	4027	2.2	<.001
Cerebrovascular disease	2215	9.0	14,554	7.9	<.001
Dementia	117	0.5	2389	1.3	<.001
Chronic pulmonary disease	3117	12.6	7125	3.9	<.001
Connective tissue disease-rheumatic disease	615	2.5	2891	1.6	<.001
Peptic ulcer disease	732	3.0	3265	1.8	<.001
Mild liver disease	295	1.2	942	0.5	<.001
Diabetes without complications	1836	7.4	10,155	5.5	<.001
Diabetes with complications	326	1.3	1840	1.0	<.001
Paraplegia and hemiplegia	108	0.4	647	0.4	.036
Renal disease	325	1.3	1949	1.1	<.001
Cancer	3251	13.2	17,664	9.6	<.001
Moderate or severe liver disease	73	0.3	233	0.1	<.001
Metastatic carcinoma^a	158	0.6	1258	0.7	.49
AIDS/HIV	6	0.0	24	0.0	.158

^a 15 years to 6 months prior index date for the index cases.

Table 2. Demographic and clinical characteristics among patients diagnosed with NSCLC by Charlson comorbidity index (CCI).

	CCI 0		CCI 1–2		CCI 3+			Total
	n	%	n	%	n	%	p value	n	%
Sex
Male	6776	51.4	4541	34.4	1872	14.2	–	13,189	100
Female	6980	60.6	3470	30.1	1064	9.2	<.001	11,514	100
Age at diagnosis
0–59	3259	76.3	833	19.5	177	4.1	–	4269	100
60–69	5079	60.9	2497	29.9	770	9.2	–	8346	100
70–79	3981	47.1	3182	37.7	1287	15.2	–	8450	100
80–89	1394	39.9	1425	40.8	676	19.3	–	3495	100
90+	43	30.1	74	51.7	26	18.2	<.001	143	100
Level of education
Low	5896	51.6	4010	35.1	1528	13.4	–	11,434	100
Middle	5483	58.3	2897	30.8	1032	11.0	–	9412	100
High	2129	62.5	963	28.3	312	9.2	<.001	3404	100
Smoking history
Smoker	6761	59.8	3420	30.3	1123	9.9	–	11,304	100
Former smoker	5000	49.3	3613	35.6	1522	15.0	–	10,135	100
Never smoker	1689	63.4	754	28.3	219	8.2	<.001	2662	100
Calender period
2002–2006	6490	57.4	3626	32.1	1191	10.5	–	11,307	100
2007–2011	7266	54.2	4385	32.7	1745	13.0	<.001	13,396	100
Cause of death
Alive	2248	59.0	1194	31.4	365	9.6	–	3807	100
Lung cancer	10,562	57.2	5858	31.7	2037	11.0	–	18,457	100
Other Causes	946	38.8	959	39.3	534	21.9	<.001	2439	100
WHO PS
0	3162	67.0	1244	26.4	311	6.6	–	4717	100
1	5511	58.3	2946	31.2	996	10.5	–	9453	100
2	2718	50.2	1939	35.8	760	14.0	–	5417	100
3	1388	45.5	1135	37.2	529	17.3	–	3052	100
4	536	46.5	416	36.1	201	17.4	<.001	1153	100
Histopathology
Adenocarcinoma	7955	59.3	4078	30.4	1388	10.3	–	13,421	100
Squamous cell	3260	48.3	2436	36.1	1054	15.6	–	6750	100
Large cell	2381	56.1	1398	33.0	462	10.9	–	4241	100
Adenosquamous	160	55.0	99	34.0	32	11.0	<.001	291	100
Stage at diagnosis
IA–IIB	2827	48.9	2112	36.5	845	14.6	–	5784	100
IIIA	1115	53.7	693	33.3	270	13.0	–	2078	100
IIIB–IV	9589	58.6	5026	30.7	1743	10.7	<.001	16,358	100
Multidisciplinary conf.
No	5107	55.3	3017	32.7	1116	12.1		9240	100
Yes	7933	56.4	4522	32.1	1620	11.5	.202	14,075	100

Table 3. Treatment among patients diagnosed with NSCLC by Charlson comorbidity index (CCI), binary logistic regression with odds ratios and/or 95% confidence intervals (CI).

	CCI 0				CCI 1-2				CCI 3+				Total
	n	%	aOR**	95% CI	n	%	aOR**	95% CI	n	%	aOR**	95% CI	n	%
Stage IA–IIB, who PS 0–2	–	–	–	–	–	–	–	–	–	–	–	–	–	–
Planned surgery	2178	80.7	1.00	ref.	1334	69.0	0.69	0.58–0.83	413	56.4	0.46	0.36–0.57	3925	73.2
Stereotactic radiotherapy*	57	14.8	1.00	ref.	112	32.4	1.94	1.22–3.10	84	46.7	2.51	1.46–4.32	253	27.8
Stage IIIA, who PS 0–2
Planned surgery	207	20.5	1.00	ref.	84	13.8	0.92	0.68–1.24	21	9.8	0.74	0.44–1.23	312	17.0
Chemo/RT*	278	48.1	1.00	ref.	126	36.2	0.74	0.55–0.99	53	39.3	1.12	0.73–1.71	457	43.1
Radiotherapy	489	48.3	1.00	ref.	268	44.0	0.80	0.64–0.99	105	49.5	1.12	0.82–1.53	862	47.0
Stage IIIB–IV, who PS 0–2
Chemotherapy	6176	82.5	1.00	ref.	2668	76.6	0.97	0.87–1.08	754	69.7	0.76	0.65–0.89	9598	79.6
Radiotherapy	1531	20.5	1.00	ref.	741	21.3	1.03	0.92–1.15	224	20.7	1.03	0.87–1.23	2496	20.7

*Only available from 2007 and onwards.

**Adjusted odds ratios; adjusted for sex, age at diagnosis, year of diagnosis, level of education, smoking history, stage at diagnosis, performance status and histology.

Table 4. Overall and cause-specific mortality expressed as crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) by stage at diagnosis and performance status 0–2.

	Overall mortality				Cause-specific mortality
	HR	95% CI	aHR*	95% CI	HR	95% CI	aHR*	95% CI
Stage IA–IIB, who PS 0–2
CCI 0	1.00	ref.	1.00	ref.	1.00	ref.	1.00	ref.
CCI 1–2	1.32	1.21–1.43	1.17	0.96–1.43	1.13	1.03–1.24	0.90	0.71–1.13
CCI 3+	1.77	1.59–1.96	1.50	1.18–1.90	1.33	1.17–1.52	1.08	0.81–1.44
Stage IIIA, who PS 0–2
CCI 0	1.00	ref.	1.00	ref.	1.00	ref.	1.00	ref.
CCI 1–2	1.29	1.15–1.44	1.12	0.95–1.32	1.20	1.07–1.35	1.08	0.91–1.29
CCI 3+	1.44	1.23–1.70	1.07	0.85–1.34	1.23	1.03–1.48	0.91	0.71–1.17
Stage IIIB–IV, who PS 0–2
CCI 0	1.00	ref.	1.00	ref.	1.00	ref.	1.00	ref.
CCI 1–2	1.09	1.05–1.14	0.97	0.93–1.02	1.06	1.01–1.10	0.95	0.91–1.00
CCI 3+	1.19	1.11–1.27	0.97	0.91–1.04	1.09	1.02–1.17	0.91	0.85–0.98

* Adjusted hazard ratios; adjusted for treatment, sex, age at diagnosis, year of diagnosis, level of education, smoking history, stage at diagnosis, performance status and histology.