Phenotypic comorbidity network analysis of nasopharyngeal carcinoma: a multicenter study based on hospital discharge records.

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.