# The impact of comorbidities on the all-cause mortality of surgically treated non-small cell lung cancer patients - visualization with the aid of a comorbidome

## TL;DR

This study found that certain rare comorbidities, like chronic lymphatic leukemia, strongly affect mortality in lung cancer patients after surgery.

## Contribution

The study introduces a novel approach to visualize and analyze the impact of comorbidities on mortality using a comorbidome.

## Key findings

- Chronic lymphatic leukemia had the strongest association with death in lung cancer patients.
- Comorbidities with high mortality impact tend to be rare in the patient population.
- Surgical approach (minimally invasive vs. thoracotomy) influenced which comorbidities were most impactful.

## Abstract

Lung cancer patients often have multiple comorbidities. This study aimed to determine which comorbidities had an impact on all-cause mortality in lung cancer patients who had undergone surgical treatment.

This retrospective study reviewed data from all lung cancer patients who underwent lobectomy or segmentectomy at the Lung Cancer Center Munich between 2011 and 2020. We compared numerical outcomes between patients with minimally invasive surgery and patients with thoracotomy using t-test, and categorical outcomes using Chi2-test or fishers exact test when cell counts were < 6. We used multivariate Cox Regression to model the association between comorbidities and overall survival.

1658 patients (556 minimally invasive,1102 thoracotomy) were included. Across the entire population the comorbidity with the strongest association to death was chronic lymphatic leukemia (HR = 5.15, p = < 0.001), followed by pulmonary fibrosis (HR = 4.06, p = < 0.001), mild liver disease (HR = 2.18, p = 0.02), peripheral arterial disease (HR = 1.48, p = 0.04) and chronic obstructive pulmonary disease (HR = 1.42, p = < 0.01). In the minimally invasive surgery group chronic lymphatic leukemia was most strongly associated with death (HR = 14.31, p = 0.01). This was followed by mild liver disease (HR = 5.01, p = 0.01) and myocardial infarction (HR = 2.45, p = 0.04). Whereas in the thoracotomy group the strongest associations were fibrosis (HR = 4.20, p = < 0.001) and COPD (HR = 1.51,p = < 0.01).

Most of the comorbidities analyzed do not have a major impact on all-cause mortality after lung surgery. Those that do have a high impact tend to have a very low prevalence.