Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Population
2.2. Inclusion and Exclusion Criteria
2.3. Propensity Score Matching and Covariates
2.4. Statistics
3. Results
3.1. Propensity Score Matching and Study Cohort
3.2. Prognostic Factors of All-Cause Mortality after Multivariate Cox Regression Analysis
3.3. Kaplan–Meier OS among Non-COPD, COPD, and Hospitalization for COPDAE
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | Non-COPD Patients | COPD Patients | p-Value | ||
---|---|---|---|---|---|
N = 644 | (100%) | N = 322 | (100%) | ||
Age (mean ± SD) | (71.96 ± 10.10) | (71.51 ± 9.72) | 0.821 | ||
Age (years) | 0.372 | ||||
≤65 | 153 | 23.76% | 74 | 22.98% | |
65–75 | 224 | 34.78% | 109 | 33.85% | |
75–85 | 221 | 34.32% | 110 | 34.16% | |
>85 | 46 | 7.14% | 29 | 9.00% | |
Sex | 0.788 | ||||
Female | 205 | 31.83% | 99 | 30.75% | |
Male | 439 | 68.17% | 223 | 69.25% | |
Diabetes | 0.306 | ||||
No | 462 | 71.74% | 220 | 68.32% | |
Yes | 182 | 28.26% | 102 | 31.68% | |
Hyperlipidemia | 0.588 | ||||
No | 470 | 72.98% | 241 | 74.84% | |
Yes | 174 | 27.02% | 81 | 25.16% | |
Hypertension | 0.769 | ||||
No | 587 | 91.15% | 292 | 90.68% | |
Yes | 57 | 8.85% | 30 | 9.32% | |
CKD | 0.998 | ||||
No | 633 | 98.29% | 316 | 98.14% | |
Yes | 11 | 1.71% | 6 | 1.86% | |
Cardiovascular diseases | 0.822 | ||||
No | 551 | 85.56% | 273 | 84.78% | |
Yes | 93 | 14.44% | 49 | 15.22% | |
CCI score | 0.876 | ||||
0 | 394 | 61.18% | 200 | 62.11% | |
≥1 | 250 | 38.82% | 122 | 37.89% | |
AJCC pathologic stages | 0.950 | ||||
I | 27 | 4.19% | 16 | 4.97% | |
II | 180 | 27.95% | 90 | 27.95% | |
IIIA | 177 | 27.48% | 87 | 27.02% | |
IIIB | 216 | 33.54% | 106 | 32.92% | |
IIIC | 44 | 6.83% | 23 | 7.14% | |
Grade of differentiation | 0.881 | ||||
Low | 201 | 31.21% | 107 | 33.23% | |
Moderate | 315 | 48.91% | 154 | 47.83% | |
High | 128 | 19.88% | 61 | 18.94% | |
Lymphovascular invasion | 0.726 | ||||
No | 401 | 62.27% | 196 | 60.87% | |
Yes | 243 | 37.73% | 126 | 39.13% | |
Perineural invasion | 0.741 | ||||
No | 440 | 68.32% | 223 | 69.25% | |
Yes | 204 | 31.68% | 99 | 30.75% | |
Margin (distal and circumferential margin) | 0.212 | ||||
Negative | 619 | 96.12% | 308 | 95.65% | |
Positive | 25 | 3.88% | 14 | 4.35% | |
Neoadjuvant CCRT | 0.601 | ||||
No | 307 | 47.67% | 160 | 49.69% | |
Yes | 337 | 52.33% | 162 | 50.31% | |
Adjuvant chemotherapy | 0.855 | ||||
No | 295 | 45.81% | 149 | 46.63% | |
Yes | 349 | 54.19% | 173 | 53.73% | |
Incomes Levels | 0.811 | ||||
Low (<20,000 NTD) | 330 | 51.24% | 168 | 52.17% | |
Middle (20,000–30,000 NTD) | 229 | 35.56% | 116 | 36.02% | |
High (>30,000 NTD) | 85 | 13.20% | 38 | 11.81% | |
Frequency of Hospitalizations for COPDAE (1 year before rectal cancer) | <0.001 | ||||
0 | 644 | 100.00% | 206 | 63.98% | |
1 | 0 | 0.00% | 59 | 18.32% | |
≥2 | 0 | 0.00% | 57 | 17.70% | |
Follow up (Death) | <0.001 | ||||
Years, Median (IQR, Q1, Q3) | 4.64 (1.53, 7.04) | 3.40 (1.11, 5.53) | |||
Follow up (Death) | <0.001 | ||||
Years (mean ± SD) | 5.74 ± 4.06 | 3.95 ± 3.45 | |||
Death | 0.039 | ||||
No | 346 | 53.73% | 148 | 45.96% | |
Yes | 298 | 46.27% | 174 | 54.04% |
Variables | Crude HR (95% CI) | Adjusted HR * (95% CI) | p-Value | ||
---|---|---|---|---|---|
COPD status (ref: non-COPD) | |||||
COPD | 1.41 | (1.17, 1.71) | 1.25 | (1.04, 1.51) | 0.019 |
Frequency of hospitalization for COPDAE before rectal cancer (ref: 0) | |||||
1 | 1.42 | (1.01, 1.93) | 1.17 | (1.05, 1.51) | 0.021 |
≥2 | 2.33 | (1.63, 3.36) | 1.48 | (1.03, 2.41) | 0.024 |
Sex (ref: Female) | |||||
Male | 0.95 | (0.79, 1.16) | 1.09 | (0.87, 1.31) | 0.432 |
Age (years; ref: ≤65 y) | |||||
65–75 | 1.71 | (1.27, 2.25) | 1.37 | (1.02, 1.84) | 0.023 |
75–85 | 2.44 | (1.75, 3.33) | 2.23 | (1.70, 3.01) | <0.001 |
>85 | 4.62 | (3.30, 6.91) | 3.94 | (2.61, 5.90) | <0.001 |
CCI Score (ref: 0) | |||||
≥1 | 1.61 | (1.34, 1.93) | 1.49 | (1.19, 1.86) | <0.001 |
Diabetes (ref: No) | |||||
Yes | 1.46 | (1.15, 1.86) | 1.16 | (0.86, 1.57) | 0.284 |
Hyperlipidemia (ref: No) | |||||
Yes | 1.02 | (0.73, 1.13) | 1.01 | (0.63, 1.04) | 0.183 |
Hypertension (ref: No) | |||||
Yes | 1.07 | (0.78, 1.19) | 1.01 | (0.71, 1.14) | 0.691 |
Cardiovascular diseases (ref: No) | |||||
Yes | 1.91 | (1.21, 2.44) | 1.17 | (0.88, 1.81) | 0.277 |
CKD (ref: No) | |||||
Yes | 1.07 | (0.80, 1.19) | 1.04 | (0.73, 1.16) | 0.505 |
Lymphovascular invasion (ref: No) | |||||
Yes | 1.41 | (1.10, 1.81) | 1.12 | (0.81, 1.57) | 0.288 |
Perineural invasion (ref: No) | |||||
Yes | 1.82 | (1.36, 2.42) | 1.16 | (0.78, 1.69) | 0.295 |
Pathologic stage (ref: Stage I) | |||||
II | 1.72 | (1.02, 3.11) | 1.21 | (0.81, 2.19) | 0.462 |
IIIA | 2.13 | (1.55, 2.90) | 1.55 | (1.12, 2.77) | 0.021 |
IIIB | 2.85 | (1.70, 3.71) | 1.85 | (1.18, 3.27) | 0.019 |
IIIC | 3.26 | (1.80, 6.19) | 1.97 | (1.07, 3.58) | 0.031 |
Grade of differentiation (ref: Low grade) | |||||
Moderate | 1.37 | (1.12, 1.68) | 1.14 | (1.07, 1.52) | 0.009 |
High | 1.44 | (1.18, 1.71) | 1.23 | (1.03, 1.41) | 0.017 |
Neoadjuvant CCRT (ref: No) | |||||
Yes | 0.71 | (0.60, 1.04) | 0.81 | (0.63, 1.03) | 0.213 |
Adjuvant chemotherapy (ref: No) | |||||
Yes | 0.88 | (0.75, 1.19) | 0.86 | (0.73, 1.15) | 0.534 |
Incomes Levels (ref: low) | |||||
Middle (20,000–30,000 NTD) | 1.11 | (1.01, 1.27) | 1.03 | (0.97, 1.21) | 0.059 |
High (>30,000 NTD) | 1.24 | (1.03, 1.39) | 1.13 | (0.83, 1.30) | 0.066 |
Margin status (ref: Negative) | |||||
Positive | 1.09 | (0.91, 1.32) | 1.04 | (0.90, 1.30) | 0.057 |
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Zhang, J.; Chiu, K.-C.; Lin, W.-C.; Wu, S.-Y. Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study. Cancers 2021, 13, 4221. https://doi.org/10.3390/cancers13164221
Zhang J, Chiu K-C, Lin W-C, Wu S-Y. Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study. Cancers. 2021; 13(16):4221. https://doi.org/10.3390/cancers13164221
Chicago/Turabian StyleZhang, Jiaqiang, Kuo-Chin Chiu, Wei-Chun Lin, and Szu-Yuan Wu. 2021. "Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study" Cancers 13, no. 16: 4221. https://doi.org/10.3390/cancers13164221