Influence of Medical Comorbidities on the Presentation and Outcomes of Stage I-III None-Small-Cell Lung Cancer

Disparities in none-small-cell lung cancer (NSCLC) presentation, treatment, and outcomes are affected by many factors and patient characteristics. To determine whether medical comorbidities account for these findings, we used a validated medical comorbidity index in an analysis of patients with stage I to III NSCLC. Our findings showed that patients with a higher degree of medical comorbidities might be more likely to present with early stage disease. Despite this association, a higher degree of comorbidity burden predicted worse clinical outcomes. Background: Nonesmall-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.