The Prognostic Importance Of Comorbidity In A Hospital-Based Cancer Registry

Jay F. Piccirillo, MD, FACS
Ryan M. Tierney, MD
Irene Costas, MPH
Lori Grove, CTR
Edward L. Spitznagel, Jr., PhD

JAMA. 2004;(291)2441-2447.





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Additional Figures and Tables

Relationship Between Severity of Comorbidity and Overall Survival*

(Partial Χ2 Due to Comorbidity = 523.54; df = 3; p<0.0001)
*Curves adjusted for race, gender, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Lung Cancer*

(Partial Χ2 Due to Comorbidity = 27.60; df = 3; p<0.0001)
*Curves adjusted for race, gender, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Prostate Cancer*

(Partial Χ2 Due to Comorbidity = 155.66; df = 3; p<0.0001)
*Curves adjusted for race, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Breast Cancer*

(Partial Χ2 Due to Comorbidity = 26.03 df = 3; p<0.0001)
*Curves adjusted for race, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of the Digestive System Cancer*

(Partial Χ2 Due to Comorbidity = 32.45 df = 3; p<0.0001)
*Curves adjusted for race, gender, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Gynecologic Cancer*

(Partial Χ2 Due to Comorbidity = 17.32 df = 3; p<0.0001)
*Curves adjusted for race, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Urinary System Cancer*

(Partial Χ2 Due to Comorbidity = 26.41 df = 3; p<0.0001)
*Curves adjusted for race, gender, stage, and age



Relationship Between Severity of Comorbidity and Overall Survival of Head and Neck Cancer*

(Partial Χ2 Due to Comorbidity = 26.41 df = 3; p<0.0001)
*Curves adjusted for race, gender, stage, and age



__________________________________________

The conjoined effect of comorbidity and tumor stage on survival was demonstrated in each cancer site by creating new variables that were combinations of the different levels of comorbidity and tumor stage. For each cancer, the conjoined category of comorbidity level None and tumor stage Local was selected as the reference category. Hazard ratios and 95% confidence intervals were calculated for the eleven other combinations of comorbidity and tumor stage categories and were adjusted for age, gender, race, and, in the case of gynecological and head and neck cancers, anatomic subsite.



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Lung Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None167 (21.3)
1.00
Reference		343 (31.7)
3.40
[2.47, 4.68]		355 (39.3)
11.24
[8.21, 15.41]
Mild209 (26.6)
1.44
[0.99, 2.10]		332 (30.7)
3.94
[2.86, 5.42]		270 (29.9)
11.00
[7.98, 15.16]
Moderate245 (31.2)
2.23
[1.59, 3.14]		272 (25.2)
3.94
[2.85, 5.46]		186 (20.6)
11.36
[8.15, 15.83]
Severe165 (21.0)
3.10
[2.18, 4.42]		134 (12.4)
5.07
[3.57, 7.20]		93 (10.3)
11.78
[8.16, 17.00]
Total 786 1081 904

* Hazard ratio (HR) adjusted for age, gender, and race



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Prostate Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None1812 (54.8)
1.00
Reference		471 (58.3)
1.67
[1.01, 2.73]		42 (44.7)
22.04
[13.09, 37.14]
Mild1037 (31.4)
1.93
[1.31, 2.84]		258 (31.9)
1.68
[0.89,3.16]		33 (35.1)
26.93
[15.95, 45.48]
Moderate357 (10.8)
5.58
[3.80, 8.18]		65 (8.0)
4.35
[2.13, 8.89]		9 (9.6)
34.6
[15.9, 75.6]
Severe98 (3.0)
15.5
[10.03, 24.01]		14 (1.7)
18.19
[7.77, 42.61]		10 (10.6)
54.79
[24.81, 121]
Total 3304 808 94

* Hazard ratio (HR) adjusted for age and race



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Breast Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None916 (50.0)
1.00
Reference		502 (59.8)
5.75
[3.90, 8.50]		103 (62.1)
30.52
[20.00, 46.56]
Mild542 (29.6)
1.37
[0.83, 2.28]		207 (24.7)
5.78
[3.67, 9.08]		35 (21.1)
21.76
[12.43, 38.11]
Moderate286 (15.6)
3.32
[2.09, 5.27]		77 (9.2)
8.03
[4.53, 14.25]		15 (9.0)
33.34
[15.94, 69.72]
Severe90 (4.9)
6.25
[3.38, 11.57]		53 (6.3)
6.58
[3.24, 13.37]		13 (7.8)
42.42
[20.26, 88.83]
Total 1834 839 166

* Hazard ratio (HR) adjusted for age and race



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Digestive System Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None249 (33.9)
1.00
Reference		464 (38.2)
2.86
[1.98, 4.14]		257 (42.8)
13.71
[9.54, 19.72]
Mild239 (32.6)
1.66
[1.07, 2.56]		403 (33.2)
3.36
[2.32, 4.86]		198 (33.0)
13.76
[9.48, 19.98]
Moderate165 (22.5)
2.43
[1.58, 3.74]		249 (20.5)
4.33
[2.96, 6.34]		96 (16.0)
14.93
[9.99, 22.32]
Severe81 (11.0)
4.21
[2.66, 6.66]		99 (8.2)
4.98
[3.19, 7.76]		50 (8.3)
15.33
[9.67, 24.32]
Total 734 1215 601

* Hazard ratio (HR) adjusted for age, gender, and race



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Gynecologic Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None719 (54.1)
1.00
Reference		379 (52.0)
5.34
[3.87, 7.38]		226 (47.4)
14.33
[10.19, 20.14]
Mild339 (25.5)
1.16
[0.76, 1.77]		198 (27.2)
5.20
[3.65, 7.42]		154 (32.3)
16.91
[11.85, 24.15]
Moderate221 (16.6)
2.09
[1.38, 3.17]		116 (15.9)
4.21
[2.79, 6.34]		72 (15.1)
19.76
[13.05, 29.93]
Severe50 (3.8)
2.67
[1.31, 5.43]		36 (4.9)
8.84
[5.10, 15.31]		25 (5.2)
31.29
[17.61, 55.59]
Total 1329 729 477

* Hazard ratio (HR) adjusted for age, race, and anatomic sub-site



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Urinary Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None255 (27.9)
1.00
Reference		100 (34.8)
4.24
[2.71, 6.65]		53 (40.2)
21.25
[13.59, 33.22]
Mild258 (28.2)
1.16
[0.74, 1.84]		81 (28.2)
4.19
[2.62, 6.70]		42 (31.8)
20.51
[12.73, 33.06]
Moderate263 (28.7)
2.13
[1.42, 3.18]		76 (26.5)
4.15
[2.57, 6.72]		18 (13.6)
20.35
[10.85, 38.17]
Severe139 (15.2)
3.29
[2.15, 5.04]		30 (10.5)
6.02
[3.40, 10.64]		19 (14.4)
24.58
[13.24, 45.63]
Total 915 287 132

* Hazard ratio (HR) adjusted for age, gender, and race



Adjusted Hazard Ratio as a Function of Comorbidity and Tumor Stage for Head and Neck Cancer



Comorbidity Localized
N(%)
HR*
[95% CI]		 Regional
N(%)
HR*
[95% CI]		 Distant
N(%)
HR*
[95% CI]
None208 (47.7)
1.00
Reference		267 (45.4)
4.58
[2.91, 7.21]		25 (40.3)
9.85
[5.02, 19.30]
Mild126 (28.9)
1.83
[1.04, 3.22]		179 (30.4)
4.17
[2.59, 6.71]		19 (30.7)
8.44
[3.88, 18.35]
Moderate75 (17.2)
4.13
[2.445, 6.97]		102 (17.4)
7.25
[4.48, 11.75]		11 (17.7)
14.81
[6.60, 33.25]
Severe27 (6.2)
3.58
[1.74, 7.40]		40 (6.8)
9.96
[5.71 17.38]		7 (11.3)
37.88
[15.02, 95.51]
Total 436 40 62

* Hazard ratio (HR) adjusted for age, gender, race, and anatomic sub-site



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