동반질환 중증도가 유방암 환자의 사망 위험에 미치는 요인
Factors of Specific Comorbidities Severity on the Risk of Mortality among Breast Cancer Survivors
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연구배경: 암 환자의 동반질환은 사망 위험, 진행 및 치료과정에 영향을 미친다. 따라서 동반질환과 그 중증도를 측정하여 암 생존자에 대한 예후를 정확하게 예측할 필요가있다. 방법: 본 연구는 국민건강보험공단의 표본 코호트 데이터베이스에서 추출한 유방암 환자에서 Charlson 동반질환지수(CCI)를 기준으로 주요 동반질환의 빈도를 분석하였다. 사망자와 암 생존자 간 연령, 진단 기간 및 CCI의 상대적인영향을 측정하기 위해 로지스틱 회귀분석을 수행하였다. 유방암 환자의 생존 예측인자로서 CCI에 따른 사망위험률을확인하기 위하여 콕스의 비례위험 회귀분석을 적용하였다. 결과: 첫째, Charlson 동반질환지수에 기초한 빈도 분석에서 주요 동반질환은 폐질환에 이어 소화성 궤양 및 전이성 암의 순이었다. 둘째, 나이가 들수록 동반질환 중증도가높고 사망 위험이 높다. 셋째, 교란을 유발할 수 있는 변수(나이, BMI, 흡연력, 음주력 및 출산력)를 보정한 모형에서연령과 BMI는 사망 위험을 높였다. 결론: 동반질환의 중증도는 유방암 환자의 사망 위험을크게 증가시켰다. 특히 60세 이상, BMI가 높고 흡연경력이있는 암 생존자들은 예후가 좋지 않아 지속적인 치료 및 사후관리가 요구된다.
Abstract
Background: For cancer patients, comorbidities affect the risk, progression, and process of treatment. They negatively affect prognoses by increasing mortality. It is therefore necessary to predict prognoses accurately for cancer survivors by measuring comorbidities and their severity. Methods: In this study, the frequency of comorbidities was analyzed on the basis of the Charlson comorbidity index (CCI) in breast cancer patients drawn from the National Health Insurance Service-National Sample Cohort data. This study examined the relative effects of certain factors (age, diagnosis period, and CCI) between deaths and cancer survivors with logistic regression analysis. We applied Cox's proportional hazard regression analysis to predict the risk of mortality according to CCI as a survival predictor of breast cancer patients using three models with correction for age, including the body mass index (BMI), smoking status, alcohol intake, and childbirth history. Results: The frequency analysis based on CCI found that the most frequent type of condition was pulmonary disease (2,262; 21.5%), followed by peptic ulcer (2,019; 19.2%), and metastatic cancer (1,821; 17.3%). The older one gets, the greater one’s risk of mortality with more severe comorbidities. Age and BMI led to greater risk of mortality, with correction for the variables (age, BMI, smoking status, alcohol intake and childbirth history) that could cause confounding. Conclusions: Severity of comorbidities significantly increased the risk of mortality for breast cancer patients. In particular, those cancer survivors who are aged ≥60 years, who have high BMI, and who once smoked need to get continuous care due to poor prognoses.
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