Introduction: Comorbidities affect diagnosis and treatments in cancer patients. This study explores the prevalence and patterns of comorbidities in non-small cell lung cancer (NSCLC) patients and their association with survival. Materials and Methods: This retrospective population-based cohort study included 1674 incident NSCLC patients. Comorbidities were classified based on the ICD-9-CM system, with 13 disease categories analyzed. Patients with more than two comorbidities were classified into three mutually exclusive and exhaustive latent classes (Latent Class Analysis [LCA]). The optimal number of latent classes was determined by applying the Akaike Information Criterion. Cox regression models were run to assess overall and cancer-specific mortality, adjusting for the comorbidity groups, sex, age, and stage at diagnosis. Results: In 1674 NSCLC patients, the most prevalent medical conditions were respiratory (35.8%) and cardiovascular (33.5%). The Cox regression showed that even one comorbidity is associated with an increased hazard of overall mortality (HR = 1.33, 95%CI: 1.11–1.59,p= 0.002). LCA-derived Class-1 (cardiovascular-respiratory and endocrine) reported HR = 1.74 (95%CI: 1.39–2.17,p< 0.001), Class-2 (multi-organ) HR = 1.44 (95%CI: 1.18–1.77,p< 0.001), and Class-3 (socio-multifactorial-neuro) HR = 1.62 (95%CI: 1.36–1.93,p< 0.001). Instead, in patients with one comorbidity, NSCLC-specific mortality showed no significant trend towards increased risk (HR = 1.17, 95%CI: 1.00–1.43,p= 0.114). Significant associations emerged between NSCLC-specific mortality and LCA-classes: Class-1: HR = 1.49 (95%CI: 1.20–1.91,p= 0.001); Class-2 HR = 1.25 (95%CI: 1.0–1.57p= 0.048); and Class-3: HR = 1.23 (95%CI: 1.00–1.48,p= 0.035). Conclusions: The adverse impact of comorbidities on NSCLC-specific mortality requires their inclusion as risk factors in cancer treatment and prognosis.
引言：合并症影响癌症患者的诊断与治疗。本研究探讨非小细胞肺癌（NSCLC）患者合并症的患病率、分布模式及其与生存期的关联。材料与方法：这项基于人群的回顾性队列研究纳入1674例新发NSCLC患者。合并症根据ICD-9-CM系统分类，共分析13类疾病。具有两种以上合并症的患者通过潜在类别分析（LCA）划分为三个互斥且完备的潜在类别。采用赤池信息准则确定最佳潜在类别数。通过构建Cox回归模型评估总体死亡率和癌症特异性死亡率，并校正合并症分组、性别、年龄及诊断分期等因素。结果：在1674例NSCLC患者中，呼吸系统疾病（35.8%）和心血管疾病（33.5%）最为常见。Cox回归显示，即使仅存在一种合并症也与总体死亡风险增加相关（HR=1.33，95%CI：1.11-1.59，p=0.002）。LCA分类显示：第1类（心血管-呼吸与内分泌疾病）HR=1.74（95%CI：1.39-2.17，p<0.001）；第2类（多器官疾病）HR=1.44（95%CI：1.18-1.77，p<0.001）；第3类（社会-多因素-神经系统疾病）HR=1.62（95%CI：1.36-1.93，p<0.001）。而仅有一种合并症的患者中，NSCLC特异性死亡率未呈现显著上升趋势（HR=1.17，95%CI：1.00-1.43，p=0.114）。NSCLC特异性死亡率与LCA分类存在显著关联：第1类HR=1.49（95%CI：1.20-1.91，p=0.001）；第2类HR=1.25（95%CI：1.0-1.57，p=0.048）；第3类HR=1.23（95%CI：1.00-1.48，p=0.035）。结论：合并症对NSCLC特异性死亡率的不利影响提示，应将其作为风险因素纳入癌症治疗及预后评估体系。
Patterns of Comorbidities in Lung Cancer Patients and Survival
肿瘤(癌症)患者之家