Max J Gordon, Zhigang Duan, Hui Zhao, Loretta Nastoupil, Swaminathan Iyer, Alessandra Ferrajoli, Alexey V Danilov, Sharon H Giordano
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引用次数: 0
Abstract
Purpose: Compare the association of individual comorbidities, comorbidity indices, and survival in older adults with non-Hodgkin lymphoma (NHL), including in specific NHL subtypes.
Methods: Data source was SEER-Medicare, a population-based registry of adults age 65 years and older with cancer. We included all incident cases of NHL diagnosed during 2008-2017 who met study inclusion criteria. Comorbidities were classified using the three-factor risk estimate scale (TRES), Charlson comorbidity index (CCI), and National Cancer Institute (NCI) comorbidity index categories and weights. Overall survival (OS) and lymphoma-specific survival, with death from other causes treated as a competing risk, were estimated using the Kaplan-Meier method from time of diagnosis. Multivariable Cox models were constructed, and Harrel C-statistics were used to compare comorbidity models. A two-sided P value of <.05 was considered significant.
Results: A total of 40,486 patients with newly diagnosed NHL were included. Patients with aggressive NHL had higher rates of baseline comorbidity. Despite differences in baseline comorbidity between NHL subtypes, cardiovascular, pulmonary, diabetes, and renal comorbidities were frequent and consistently associated with OS in most NHL subtypes. These categories were used to construct a candidate comorbidity score, the non-Hodgkin lymphoma 5 (NHL-5). Comparing three validated comorbidity scores, TRES, CCI, NCI, and the novel NHL-5 score, we found similar associations with OS and lymphoma-specific survival, which was confirmed in sensitivity analyses by NHL subtypes.
Conclusion: The optimal measure of comorbidity in NHL is unknown. Here, we demonstrate that the three-category TRES and five-category NHL-5 scores perform as well as the 14-16 category CCI and NCI scores in terms of association with OS and lymphoma-specific survival. These simple scores could be more easily used in clinical practice without prognostic loss.
目的：比较患有非霍奇金淋巴瘤（NHL）的老年人（包括特定的 NHL 亚型）的个人合并症、合并症指数和生存率之间的关系：数据来源于 SEER-Medicare，这是一个以人口为基础的 65 岁及以上癌症成人登记系统。我们纳入了 2008-2017 年期间确诊的所有符合研究纳入标准的 NHL 病例。合并症采用三因素风险估计量表（TRES）、查尔森合并症指数（CCI）和美国国家癌症研究所（NCI）合并症指数类别和权重进行分类。采用卡普兰-梅耶（Kaplan-Meier）法估算了从确诊开始的总生存期（OS）和淋巴瘤特异性生存期（其他原因导致的死亡被视为竞争风险）。建立了多变量 Cox 模型，并使用 Harrel C 统计量来比较合并症模型。结果共纳入了40486名新确诊的NHL患者。侵袭性 NHL 患者的基线合并症发生率较高。尽管NHL亚型之间的基线合并症存在差异，但在大多数NHL亚型中，心血管、肺部、糖尿病和肾脏合并症很常见，且与OS持续相关。这些类别被用来构建一个候选合并症评分，即非霍奇金淋巴瘤5（NHL-5）。通过比较 TRES、CCI、NCI 这三种已验证的合并症评分和新的 NHL-5 评分，我们发现它们与 OS 和淋巴瘤特异性生存率的关系相似，这一点在按 NHL 亚型进行的敏感性分析中得到了证实：结论：NHL合并症的最佳衡量标准尚不明确。在此，我们证明了三类 TRES 和五类 NHL-5 评分与 14-16 类 CCI 和 NCI 评分在 OS 和淋巴瘤特异性生存方面的相关性。这些简单的评分可以更方便地用于临床实践，而不会对预后造成影响。
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