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      Association between Charlson comorbidity index score and outcome in patients with stage IIIB-IV non-small cell lung cancer

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          Abstract

          Background

          This retrospective study investigated the association between the Charlson comorbidity index (CCI) score and the survival of patients with stage IIIB-IV (advanced, non-resectable) non-small cell lung cancer (NSCLC) who also did not have gene mutations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK).

          Methods

          The records of 165 patients (28–80 y, median 61 y) who met the above criteria and were admitted to Beijing Friendship Hospital Capital Medical University from 1 May 2010 to 1 October 2014were reviewed. Associations between baseline variables and the CCI score were assessed via univariate and multivariate logistic regression analysis. Overall survival was defined as the time from the first clinic visit to death from any cause, or to the end of follow-up. Survival curves were estimated via the Kaplan-Meier method and compared with the log-rank test.

          Results

          Logistic regression analyses indicated that smoking and performance status were independently associated with the CCI score. Smoking was associated with an increased risk of mortality (odds ratio (OR) 4.12 (95% confidence interval [CI] 1.92–8.84) compared to non-smokers), as was performance status 2 (ambulatory, capable of self-care, unable to perform any work activities; active for >50% of waking hours) (OR 2.22 (95% CI, 1.14–4.33) compared to performance status 1). Univariate Cox’s regression analyses showed that the hazard ratios were significantly associated with the CCI score ( P = 0.009), smoking ( P = 0.042), and male gender ( P = 0.021).

          Conclusion

          The CCI score is an important prognostic factor for the prediction of overall survival in patients with stage IIIB-IV NSCLC who are negative for EGFR and ALK gene mutations.

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          Most cited references22

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          Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial.

          Vinorelbine prolongs survival and improves quality of life in elderly patients with advanced non-small-cell lung cancer (NSCLC). Some studies have also suggested that gemcitabine is well tolerated and effective in such patients. We compared the effectiveness and toxicity of the combination of vinorelbine plus gemcitabine with those of each drug given alone in an open-label, randomized phase III trial in elderly patients with advanced NSCLC. Patients aged 70 years and older, enrolled between December 1997 and November 2000, were randomly assigned to receive intravenous vinorelbine (30 mg/m(2) of body surface area), gemcitabine (1200 mg/m(2)), or vinorelbine (25 mg/m(2)) plus gemcitabine (1000 mg/m(2)). All treatments were delivered on days 1 and 8 every 3 weeks for a maximum of six cycles. The primary endpoint was survival. Survival curves were drawn using the Kaplan-Meier method and analyzed by the Mantel-Haenszel test. Secondary endpoints were quality of life and toxicity. Of 698 patients available for intention-to-treat analysis, 233 were assigned to receive vinorelbine, 233 to gemcitabine, and 232 to vinorelbine plus gemcitabine. Compared with each single drug, the combination treatment did not improve survival. The hazard ratio of death for patients receiving the combination treatment was 1.17 (95% confidence interval [CI] = 0.95 to 1.44) that of patients receiving vinorelbine and 1.06 (95% CI = 0.86 to 1.29) that of patients receiving gemcitabine. Although quality of life was similar across the three treatment arms, the combination treatment was more toxic than the two drugs given singly. The combination of vinorelbine plus gemcitabine is not more effective than single-agent vinorelbine or gemcitabine in the treatment of elderly patients with advanced NSCLC.
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            Age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer: a review of National Cancer Institute of Canada Clinical Trials Group trials.

            This study analyzed patients enrolled in two large, prospectively randomized trials of systemic chemotherapy (adjuvant/palliative setting) for non-small-cell lung Cancer (NSCLC). The main objective was to determine if age and/or the burden of chronic medical conditions (comorbidity) are independent predictors of survival, treatment delivery, and toxicity. Baseline comorbid conditions were scored using the Charlson comorbidity index (CCI), a validated measure of patient comorbidity that is weighted according to the influence of comorbidity on overall mortality. The CCI score (CCIS) was correlated with demographic data,(ie, age, sex, race), performance status (PS), histology, cancer stage, patient weight, hemoglobin, alkaline phosphatase, lactate dehydrogenase, outcomes of chemotherapy delivery (ie, type, total dose, and dose intensity), survival, and response. A total of 1,255 patients were included in this analysis. The median age was 61 years (range, 34 to 89 years); 34% of patients were elderly (at least 65 years of age); and 31% had comorbid conditions at randomization. Twenty-five percent of patients had a CCIS of 1, whereas 6% had a CCIS of 2 or greater. Elderly patients were more likely to have a CCIS equal to or greater than 1 compared with younger patients (42% v 26%; P or = 1), rather than age more than 65 years, was associated with poorer survival.
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              Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer.

              To evaluate the impact of the Charlson comorbidity index on long-term survival in nonsmall cell lung cancer surgery and determine whether this index is a better predictor of long-term survival than individual comorbid conditions. From January 1989 to December 2001, 433 (340 men, 93 women) consecutive curative resections for nonsmall cell lung cancer were performed. Each patient was preoperatively assessed according to the Charlson comorbidity index. Survival curves were estimated by the Kaplan-Meier method. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis. The patients ranged in age from 37 to 82 years, with a mean age of 65 years. Hospital mortality was 3.7%. Five-year overall and disease free survival was 45 and 43%, respectively. Among patients with Charlson comorbidity grade 0, 5-year overall survival was 52%, among patients with Charlson comorbidity grade 1-2 it was 48%, and among patients with Charlson comorbidity grade > or =3 it was 28%. Univariate analysis showed that male gender, age, congestive heart failure, chronic pulmonary disease, Charlson comorbidity index, clinical stage, pathological stage, and type of resection were significantly associated with an impaired survival. Multivariate analysis showed that age (relative risk, 1.02; 95% confidence interval, 1.01-1.03), Charlson comorbidity grade 1-2 (relative risk, 1.4; 95% confidence interval, 1.0-1.8), Charlson comorbidity grade > or =3 (relative risk, 2.2; 95% confidence interval, 1.5-3.1), bilobectomy (relative risk, 1.7; 95% confidence interval, 1.2-2.5), pneumonectomy (relative risk, 1.5; 95% confidence interval, 1.1-2.0), pathological stage IB (relative risk, 1.5; 95% confidence interval, 1.1-2.2), IIB (relative risk, 1.9; 95% confidence interval, 1.2-3.0), IIIA (relative risk, 1.9; 95% confidence interval, 1.1-3.1), IIIB (relative risk, 2.8; 95% confidence interval, 1.2-6.8), and IV (relative risk, 12.4; 95% confidence interval, 3.2-48.2), were associated with an impaired survival. The Charlson comorbidity index is a better predictor of survival than individual comorbid conditions in nonsmall cell lung cancer surgery. We recommend the use of a validated comorbidity index in the selection of patients for NSCLC surgery.
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                Author and article information

                Contributors
                (853)8897-2438 , xjyao@must.edu.mo
                +86-010-63139321 , oncology@ccmu.edu.cn
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                15 August 2017
                15 August 2017
                2017
                : 17
                : 112
                Affiliations
                [1 ]ISNI 0000 0004 0369 153X, GRID grid.24696.3f, , Cancer Center, Beijing Friendship Hospital, Capital Medical University, ; 95 Yong An Road, Xicheng District, Beijing, 100050 China
                [2 ]State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa, Macau, 999078 China
                Article
                452
                10.1186/s12890-017-0452-0
                5556668
                28806935
                4a7f0b34-fe33-40f3-98f1-472e1276e96a
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 January 2017
                : 31 July 2017
                Funding
                Funded by: Beijing Talents Fund
                Award ID: No. 2014000021469G268
                Award Recipient :
                Funded by: Rising Star Program from Beijing Friendship Hospital, CMU
                Award ID: No. yyqdkt 2015-10
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Respiratory medicine
                charlson comorbidity,index score,outcome,advanced nsclc
                Respiratory medicine
                charlson comorbidity, index score, outcome, advanced nsclc

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