Prevalence and prognostic impact of comorbidities in sarcomas: A population-based study of 3746 patients in Hong Kong

Abstract

Background The prognostic impact of comorbidities in patients (pts) with sarcomas is not well defined. The aims of this study were to examine the prevalence of comorbidities and its impact on overall survival in pts with sarcomas.

Methods A population-based retrospective database was assembled to extract pts with sarcoma, as defined as ICD-9-CM codes of bone (170.x) or/and soft tissue (171.x) who have attended clinics or hospitals of the Hong Kong Hospital Authority between Jan 2004 and Mar 2018. Eligible pts with index presentation of bone or/and soft tissue sarcoma (STS) on or after Jan 2005 were analysed to allow 1-year window period. Comorbidities were obtained, and Charlson’s Comorbidity Score (CCS) defined by 19 medical conditions according to risk of mortality at the time of sarcoma diagnosis was calculated. CCS score and prevalence of comorbidities at diagnosis were assessed. Rate of all-cause mortality according to level of CCS were computed. The prognostic value of CCS was estimated using Cox proportional hazard models.

Results Of 3746 pts identified, 3358 pts satisfied eligibility: bone: n = 661, STS: n = 2576; both: n = 121. Male: Female 52.6%: 47.4%. Proportional age group: <18 years (y): 7.56% (n = 254); 18<40y: 15.7% (n = 529); 40<65y: 42.2% (n = 1418); 65<80y: 23.4% (n = 787); >/=80y: 11.0% (n = 370). Top 5 common co-morbidities: diabetes mellitus (9.8%); cerebrovascular disease (4.8%), ischaemic heart disease (3.8%), chronic lung disease (2.9%), congestive heart failure (2.6%). Mean age at presentation: 54.2y (bone: 46.8y, STS: 56.5y). Mean CCS: 4.6. Pts with higher CCS had higher mortality (CCS3 vs. CCS2; HR 1.49; 95% CI 1.19-1.87; p < 0.01; CCS>/=7 vs. CCS2; HR 3.20; 95% CI: 2.62-3.92; p < 0.001).

Conclusions This is the largest population-based sarcoma cohort reported from Asia. Presence of comorbidities have significant negative prognostic impact on pts with sarcomas. Identification and treatment of relevant comorbidities may improve survival of sarcoma pts.