title: Influence of medical comorbidities on the presentation and outcomes of stage I-III non-small-cell lung cancer.
abstract: BACKGROUND
  Non-small-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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Ahn
authors.forename: Nishi
authors.initials: N
authors.lastname: Mehta
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Yorio
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.forename: David E
authors.initials: DE
authors.lastname: Gerber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Charlson Index; Disparities; Early stage; Locally advanced; Treatment