目的：肺癌和心血管代谢性疾病都在我国中老年人群的主要死因中位居前列，二者有许多共同的危险因素，可在同一位患者身上出现，给我国经济社会带来巨大负担。本研究旨在从共病角度，探索心血管代谢性共病在中老年非小细胞肺癌（NSCLC）患者中的患病率及其对预后的影响。

方法：纳入2011年1月至2018年12月于我国3家肿瘤专科医院和1家综合医院确诊的3477例NSCLC患者，将心血管代谢性共病定义为NSCLC第一次确诊，且未开始治疗时合并的心血管代谢性疾病。构建Kaplan-Meier曲线进行生存分析，并利用对数秩检验进行比较。采用单因素和多因素调整的COX比例风险模型来评估与全因死亡相关的危险因素，计算死亡率的危险比（HR）和95%可信区间（95% CI）。

结果：中老年NSCLC患者心血管代谢性共病的患病率为34.4%，其中，中年NSCLC患者心血管代谢性共病的患病率为30.0%，老年NSCLC患者心血管代谢性共病的患病率为45.5%。心血管代谢性共病显著减少中年NSCLC患者（21.0个月 VS 32.0个月，P<0.01）和老年NSCLC患者（13.0个月VS 17.0个月，P=0.01）中位生存时间（MST）。心力衰竭（HR 1.754，95% CI 1.436-2.144，P<0.001）和静脉血栓栓塞（HR 2.196，95%CI 1.691-2.853，P<0.001）与中年NSCLC患者的不良预后相关，心力衰竭（HR 1.709, 95% CI 1.371-2.130, P<0.001）与老年NSCLC患者的不良预后相关，高脂血症（HR 0.741, 95% CI 0.566-0.971, P=0.030）与中年NSCLC患者更好的预后存在相关性。

结论：心血管代谢性共病在我国中老年NSCLC患者中普遍存在，与中老年NSCLC患者的预后密切相关。心血管代谢性共病的管理对于改善肿瘤患者临床结局，丰富肿瘤心脏病学实践具有重要意义。

Objective: Both lung cancer and cardiometabolic diseases are leading causes of death in China and they share some common risk factors, which bring heavy burdens on society. This study aims to explore the prevalence and survival of cardiometabolic comorbidities on middle-aged and elderly non-small cell lung cancer (NSCLC) patients.

Methods: This study recruited 3477 NSCLC patients between January 2011 and December 2018 in 3 cancer specialty hospitals and 1 general hospital in China. Cardiometabolic comorbidities in our study were defined as pre-existing cardiometabolic diseases when cancer was first diagnosed before treated. Survival analysis was demonstrated by Kaplan-Meier curves and the curves were compared with the log-rank test. Univariable and multivariable adjusted Cox proportional hazard models were conducted to evaluate the risk factors associated with mortality. Hazards ratios (HRs) for mortality and corresponding 95% confidence interval (95% CI) were calculated.

Results: The prevalence of cardiometabolic comorbidities was 34.4% in the middle-aged and elderly NSCLC patients, 30.0% in middle-aged NSCLC patients and 45.5% in elderly NSCLC patients. Log-rank analysis presented statistically differences of median survival time (MST) between patients with cardiometabolic comorbidities and without cardiometabolic comorbidities both in the middle-aged group (21.0 months VS 32.0 months, P<0.01) and elderly group (13.0 months VS 17.0 months, P=0.01). Heart failure (HR 1.754, 95% CI 1.436-2.144, P<0.001) and venous thrombus embolism (HR 2.196, 95%CI 1.691-2.853, P<0.001) were associated with worse prognosis in middle-aged NSCLC patients, while heart failure (HR 1.709, 95% CI 1.371-2.130, P<0.001) decreased overall survival in elderly patients. Hyperlipidemia was associated with better prognosis in middle-aged patients (HR 0.741, 95% CI 0.566-0.971, P=0.030).

Conclusions: Cardiometabolic comorbidities are quite common in middle-aged and elderly NSCLC patients in China, which is closely related to long-time prognosis. The management of cardiometabolic comorbidities is of great significance for improving clinical outcomes and enriching the practice of cardio-oncology.