鼻咽癌表型共病网络分析：基于医院出院记录的多中心研究

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中文摘要

背景： 鼻咽癌（NPC）患者常合并多种共病，影响治疗效果和生存。既往研究仅关注个别常见共病，缺乏对流行区NPC患者全谱慢性疾病的全面分析。本研究采用基于大规模医院出院数据的表型共病网络（PCNs），系统描述流行区NPC患者的整体共病模式。
方法： 本回顾性队列研究使用2010年1月至2023年12月期间在流行区两家大型综合医院电子病历系统中识别的NPC患者数据。诊断采用ICD-10（国际疾病分类第10版）3位数水平编码进行分类。构建PCNs以表示共病模式，其中节点代表共病，边表示显著关联。按性别和转移状态进行亚组分析。
结果： 共纳入18481例NPC患者。NPC患者的中位年龄为47-48岁。在数据集1和2中，分别有82.9%和78.2%的患者合并少于三种共病。高血压、慢性鼻窦炎、其他贫血以及液体、电解质和酸碱平衡紊乱是所有亚组中患病率最高的前4位共病。男性的平均共病数量高于女性，非转移亚组高于转移亚组。男性和非转移患者的PCNs表现出更复杂的相互连接。多种共病存在显著性别差异。慢性病毒性肝炎和肾输尿管结石在男性中占主导，而液体、电解质和酸碱平衡紊乱以及非毒性甲状腺肿在女性中更为常见。再生障碍性贫血亚组的PCN比两个继发性恶性肿瘤亚组更为复杂。
结论： 本研究揭示了NPC患者共病模式的特定特征。按性别和转移状态分层，NPC患者个体共病患病率及其复杂共存存在差异。这些发现强调了理解NPC患者共病模式及其相互作用的重要性，对于指导个性化医疗治疗以及制定疾病管理和改善预后的综合策略值得关注。

英文摘要

BACKGROUND: Nasopharyngeal carcinoma (NPC) patients frequently have multiple comorbidities that affect treatment efficacy and survival. Prior studies focused only on individual common comorbidities, lacking a comprehensive analysis of the full spectrum of chronic diseases in NPC patients from endemic areas. This study adopted phenotypic comorbidity networks (PCNs) based on large-scale hospital discharge data to systematically characterize the overall comorbidity patterns of endemic NPC patients.
METHODS: This retrospective cohort study was conducted using data from NPC patients identified in the electronic medical record systems of two large general hospitals in endemic regions between January 2010 and December 2023. Diagnoses were classified using ICD-10 (International Classification of Diseases, 10th Revision) codes at the 3-digit level. PCNs were constructed to represent comorbidity patterns, where nodes represented comorbidities, and edges depicted significant associations. Subgroup analysis was conducted by sex and metastatic status.
RESULTS: A total of 18481 NPC patients were involved in the study. NPC patients' median age was 47-48 years. In Datasets 1 and 2, 82.9% and 78.2% of patients, respectively, had fewer than three comorbidities. Hypertension, chronic sinusitis, other anemias and disorders of fluid, electrolyte and acid-base balance were the top 4 comorbidities with the highest prevalence in all subgroups. The average number of comorbidities was higher in males than in females and in the non-metastatic subgroup compared with the metastatic subgroup. PCNs in males and non-metastatic patients exhibited more complex interconnections. Significant gender disparities existed in multiple comorbidities. Chronic viral hepatitis and kidney-ureteral calculi predominated in males, while fluid, electrolyte and acid-base disturbances along with nontoxic goiter were more prevalent in females. The PCN of the aplastic anemia subgroup was more complex than those of the two secondary malignant neoplasm subgroups.
CONCLUSIONS: This study revealed the specific characteristics in comorbidity patterns of NPC patients. There were disparities in the prevalence of individual comorbidities and their complex coexistence among NPC patients as stratified by sex and metastatic status. These findings highlight the importance of understanding comorbidity patterns and their interactions in NPC patients, which are noteworthy for guiding personalized medical treatments and developing comprehensive strategies for disease management and prognosis improvement.