BACKGROUND Numerous studies have analysed the effect of comorbidity on cancer outcomes, but evidence on the association between multimorbidity and short-term mortality among colorectal cancer patients is limited. We aimed to assess this association and the most frequent patterns of multimorbidity associated with a higher short-term mortality risk among colorectal cancer patients in Spain. METHODS Data were obtained from two Spanish population-based cancer registries and electronic health records. We estimated the unadjusted cumulative incidence of death by comorbidity status at 6 months and 1 year. We used a flexible parametric model to derive the excess mortality hazard ratios (HRs) for multimorbidity after adjusting for sex, age at diagnosis, cancer stage and treatment. We estimated the adjusted cumulative incidence of death by comorbidity status and identified multimorbidity patterns. RESULTS Among the study participants, 1,048 cases were diagnosed with cancers of the colon and rectum, 2 cases with cancer of the anus with overlapping sites of the rectum and 11 cases with anal adenocarcinomas but treated as colorectal cancer patients. Among 1,061 colorectal cancer patients, 171 (16.2%) died before 6 months, 246 (23.3%) died before the 1-year follow-up, and 324 (30.5%) had multimorbidity. Patients with multimorbidity had two times higher mortality risk than those without comorbidities at 6 months (adjusted HR: 2.04; 95% confidence interval [CI]: 1.30-3.20, p = 0.002). The most frequent multimorbidity pattern was congestive heart failure + diabetes. However, patients with rheumatologic disease + diabetes had two times higher 1-year mortality risk than those without comorbidities (HR: 2.23; 95% CI: 1.23-4.07, p = 0.008). CONCLUSIONS Multimorbidity was a strong independent predictor of short-term mortality at 6 months and 1 year among the colorectal cancer patients in Spain. The identified multimorbidity pattern was consistent. Our findings might help identify patients at a higher risk for poor cancer and treatment outcomes.

中文翻译：

---

西班牙结直肠癌患者的多重发病率和短期总体死亡率：一项基于人群的队列研究。


背景大量研究分析了合并症对癌症结果的影响，但结直肠癌患者中合并症与短期死亡率之间关联的证据有限。我们的目的是评估这种关联以及与西班牙结直肠癌患者较高短期死亡风险相关的最常见的多重发病模式。方法 数据来自西班牙两个基于人口的癌症登记处和电子健康记录。我们根据合并症状态估计了 6 个月和 1 年未调整的累积死亡发生率。在调整性别、诊断年龄、癌症分期和治疗后，我们使用灵活的参数模型来得出多发病的超额死亡率风险比 (HR)。我们根据合并症状态估计了调整后的累积死亡发生率，并确定了多重发病模式。结果 在研究参与者中，1,048 例被诊断患有结肠癌和直肠癌，2 例患有直肠重叠部位的肛门癌，11 例患有肛门腺癌但作为结直肠癌患者进行治疗。在1,061名结直肠癌患者中，171名（16.2%）在6个月前死亡，246名（23.3%）在1年随访前死亡，324名（30.5%）患有多种疾病。 6 个月时，患有多种疾病的患者的死亡风险是无合并症患者的两倍（调整后 HR：2.04；95% 置信区间 [CI]：1.30-3.20，p = 0.002）。最常见的多病模式是充血性心力衰竭+糖尿病。然而，患有风湿病+糖尿病的患者的 1 年死亡风险是没有合并症的患者的两倍（HR：2.23；95% CI：1.23-4.07，p = 0.008）。 结论 多重发病率是西班牙结直肠癌患者 6 个月和 1 年短期死亡率的强有力的独立预测因素。确定的多发病模式是一致的。我们的研究结果可能有助于识别癌症风险较高和治疗结果不佳的患者。