Comorbidities and their association with the overall survival in a large European cohort with gastroesophageal cancer

Known factors that might contribute to the dismal prognosis of gastroesophageal cancer are scarce. Comorbidities pose a potential prognostic factor, yet patients with severe diseases are often excluded from clinical trials, and, thus, data from real-life cohorts is warranted. We analyzed comorbidities at the time of first cancer diagnosis and their association with overall survival (OS) in patients with gastroesophageal cancer, who were treated at the Medical University of Vienna between 1990 and 2020. Survival analyses were performed with log-rank and Cox regression analyses as appropriate. We analyzed 1574 patients (70% male, mean age 63 (SD 11.8)) with gastroesophageal cancer (13% stage I, 21% stage II, 31% stage III, 36% stage IV; 30% GEJ, 40% stomach, 30% esophagus; 79% adenocarcinoma). 79% of patients were already dead at the time of this analysis. Concerning patient characteristics, only stage (p≤0.001) and age (p≤0.001) were statistically significantly associated with the OS. Comorbidities and their association with the OS are shown in the Table. There were 147 patients (9%) without any recorded comorbidity, 310 (20%) with one, 376 (24%) with 2, 313 (20%) with 3, 230 (14%) with 4, 119 (8%) with 5, 61 (4%) with 6 diseases, 18 (1%) with 7or more comorbidities. Number of comorbidities was not associated with OS (p=0.228). In a multivariate analysis, including all variables which were statistically significant in univariate analyses, lung disease (p=0.002, HR=1.259 (1.091-1.453)), age (p≤0.001, HR=1.012 (1.007-1.018)) and stage (p≤0.001, HR=1.829 (1.717-1.948)) were statistically significantly associated with the OS.Table: 1236PComorbidities and their association with the OSComorbidityn (%)OS in months (95% CI) without vs with comorbiditypKidney183 (12%)21.3 (19.5-23.1) vs 15.8 (11.1-20.5)0.003Diabetic217 (14%)20.8 (19.2-22.4) vs 22.2 (16.8-27.6)0.954Lung290 (18%)21.4 (19.6-23.2) vs 16.9 (14.1-19.7)0.001Liver357 (23%)20.5 (18.8-22.2) vs 22.0 (17.6-26.4)0.381Orthopedic361 (23%)21.2 (19.3-23.1) vs 19.3 (16.7-21.9)0.492Infectious369 (23%)21.0 (19.2-22.8) vs 20.4 (17.2-23.6)0.759Gastrointestinal526 (33%)20.9 (19.0-22.8) vs 21.0 (17.3-24.7)0.793Cardiovascular822 (52%)21.5 (19.3-23.7) vs 19.4 (17.3-21.5)0.017Other886 (56%)21.2 (18.4-24.0) vs 20.7 (18.7-22.7)0.048 Open table in a new tab Comorbidities might play an important role concerning prognosis in gastroesophageal cancer patients. Prospective studies to evaluate large real-life cohorts are warranted to improve patient management in everyday clinical routine.