Značaj komorbiditeta za preživljavanje bolesnika s planocelularnim karcinomom larinksa

Abstract

Uvod: Komorbiditeti su bolesti ili stanja koja postoje pored glavnog oboljenja. Komorbidne bolesti mogu da utiču na izbor lečenja, kao i na stopu preživljavanja. Instrumenti za procenu komorbiditeta mogu biti: opšti - mere stepen komorbiditeta kod različitih oboljenja npr. Čarlsonov indeks komorbiditeta (Charlson Comorbidity Index ili CCI) i specifični - mere stepen komorbiditeta kod određenog oboljenja npr. Procena komorbiditeta kod odraslih-27 indeks (Adult Comorbidity Evaluation-27 index ili ACE-27 index). Ciljevi rada su: Ispitati značaj komorbiditeta za preživljavanje bolesnika s planocelularnim karcinomom larinksa pomoću CCI i ACE-27 indeksa; Odrediti da li postoji razlika u učestalosti javljanja komorbiditeta i u dužini preživljavanja između bolesnika s planocelularnim karcinomom supraglotisa u odnosu na bolesnike s karcinomom glotisa; Ispitati značaj opšteg (CCI) i specifičnog (ACE-27) indeksa u proceni preživljavanja bolesnika s planocelularnim karcinomom larinksa. Materijal i metode: U studiju je uključeno 177 novoobolelih od planocelularnog karcinoma larinksa (T1-T4) koji su lečeni hirurški ili hirurški u kombinaciji s postoperacionom radioterapijom u Klinici za otorinolaringologiju i maksilofacijalnu hirurgiju Kliničkog centra Srbije u periodu od 1.1.2000. do 31.12.2003. godine. Podaci o bolesnicima su prikupljeni iz istorija bolesti, patohistoloških izveštaja i registra za maligna oboljenja. U statističkoj analizi podataka korišćena je krivulja preživljavanja prema Kaplanu i Mejeru (Meier), log-rank test, Koksov (Cox) proporcionalni hazardni model, Man-Vitnijev (Mann-Whitney) test i Kruskal-Volisov (Kruskal-Wallis) test. Rezultati: Prema CCI, 40,1% (71) bolesnika s planocelularnim karcinomom larinksa je imalo komorbidne bolesti od kojih su najčešće bile kardiovaskularne (40,3%), respiratorne (27,8%) i gastrointestinalne (14,4%). Međutim, prema ACE-27 indeksu, 66,7% (118) bolesnika s planocelularnim karcinomom je imalo komorbidne bolesti a najčešće su bile kardiovaskularne (53,1%), respiratorne (15,6%) i gastrointestinalne (8,8%). Skoro svaki četvrti oboleli je imao dve ili više komorbidnih bolesti prema CCI, kao i prema ACE-27 indeksu...

Introduction: Comorbidities are diseases or conditions that coexist with the disease of interest. Comorbid diseases can influence the treatment of choice as well as the rate of survival. Comorbidity assessment instruments can be: general - measure the burden of comorbidity across a wide range of index conditions (the Charlson Comorbidity Index or CCI) and specific - measure the overall severity of comorbidity for a particular index disease (the Adult Comorbidity Evaluation-27 or ACE-27 index). Objectives: To examine the importance of comorbidity in the survival of patients with squamous cell carcinoma of the larynx using CCI and ACE-27 index, to determine whether there is a difference in the frequency of comorbidity and survival in patients with squamous cell carcinoma of the supraglottis than patients with glottic cancer, and to examine the importance of general (CCI) and specific (ACE-27) index to estimate survival of patients with squamous cell carcinoma of the larynx. Material and Methods: The study included 177 new cases of squamous cell carcinoma of the larynx (T1-T4) that were treated by surgery only or in combination with surgery and postoperative radiotherapy at the Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia between 1 January 2000 and 31 December 2003. The study data were obtained from medical records, pathology reports, and tumour registry abstracts. For the statistical analysis of data the Kaplan-Meier survival analysis, the log-rank test, the Cox proportional hazards regression model, the Mann-Whitney and the Kruskal-Wallis tests were used. Results: According to the CCI, 40.1% (71) patients with laryngeal squamous cell carcinoma had comorbid diseases. The most frequent comorbid ailments were related to the cardiovascular (40.3%), respiratory (27.8%) and gastrointestinal systems (14.4%). However when using the ACE-27 index it was found that 66.7% (118) had these same diseases...