Yonsei Med J.  2014 Mar;55(2):316-323.

Charlson Comorbidity Index Is an Important Prognostic Factor for Long-Term Survival Outcomes in Korean Men with Prostate Cancer after Radical Prostatectomy

Affiliations
  • 1Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. kscho99@yuhs.ac
  • 2Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea.
  • 3Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 5Clinical Trial Center for Medical Device, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To analyze overall survival (OS), prostate cancer (PCa)-specific survival (PCaSS), and non-PCaSS according to the Charlson Comorbidity Index (CCI) after radical prostatectomy (RP) for PCa.
MATERIALS AND METHODS
Data from 336 patients who had RP for PCa between 1992 and 2005 were analyzed. Data included age, preoperative prostate-specific antigen (PSA), prostate volume, clinical stage, and pathologic stage. Pre-existing comorbidities were evaluated by the CCI, and patients were classified into two CCI score categories (0, > or =1).
RESULTS
The mean age of patients was 64.31+/-6.12 years. The median PSA value (interquartile range, IQR) was 11.30 (7.35 and 21.02) ng/mL with a median follow-up period (IQR) of 96.0 (85.0 and 121.0) months. The mean CCI was 0.28 (0-4). Five-year OS, PCaSS, and non-PCaSS were 91.7%, 96.3%, and 95.2%, respectively. Ten-year OS, PCaSS, and non-PCaSS were 81.9%, 92.1%, and 88.9%, respectively. The CCI had a significant influence on OS (p=0.022) and non-PCaSS (p=0.008), but not on PCaSS (p=0.681), by log-rank test. In multivariate Cox regression analysis, OS was independently associated with the CCI [hazard ratio (HR)=1.907, p=0.025] and Gleason score (HR=2.656, p<0.001). PCaSS was independently associated with pathologic N stage (HR=2.857, p=0.031), pathologic T stage (HR=3.775, p=0.041), and Gleason score (HR=4.308, p=0.001). Non-PCaSS had a significant association only with the CCI (HR=2.540, p=0.009).
CONCLUSION
The CCI was independently associated with both OS and non-PCaSS after RP, but the CCI had no impact on PCaSS. The comorbidities of a patient should be considered before selecting RP as a curative modality for PCa.

Keyword

Prostatic neoplasms; comorbidity; survival

MeSH Terms

Comorbidity*
Follow-Up Studies
Humans
Male
Methods
Neoplasm Grading
Passive Cutaneous Anaphylaxis
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Regression Analysis
Prostate-Specific Antigen

Figure

  • Fig. 1 (A) Kaplan-Meier curves for OS, PCaSS, and (C) non-PCaSS for 336 Korean men who received radical prostatectomy. Kaplan-Meier curves and log-rank tests for (B) OS, (C) PCaSS, and (D) non-PCaSS of 336 Korean men who received radical prostatectomy according to the Charlson Comorbidity Index. (E) The iAUC which was based on Cox proportional-hazards regression model survival demonstrated that the AUC of non-PCaSS was higher than OS and PCaSS. OS, overall survival; PCaSS, prostate cancer-specific survival; non-PCaSS, non-prostate cancer-specific survival; iAUC, integrated area under the curve; CCI, Charlson Comorbidity Index; HR, hazard ratio.


Reference

1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012; 62:1–15.
Article
2. Schröder FH, Carter HB, Wolters T, van den Bergh RC, Gosselaar C, Bangma CH, et al. Early detection of prostate cancer in 2007. Part 1: PSA and PSA kinetics. Eur Urol. 2008; 53:468–477.
3. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55:74–108.
Article
4. Yun SJ, Min BD, Kang HW, Shin KS, Kim TH, Kim WT, et al. Elevated insulin and insulin resistance are associated with the advanced pathological stage of prostate cancer in Korean population. J Korean Med Sci. 2012; 27:1079–1084.
Article
5. Zhang YF, Guan YB, Yang B, Wu HY, Dai YT, Zhang SJ, et al. Prognostic value of Her-2/neu and clinicopathologic factors for evaluating progression and disease-specific death in Chinese men with prostate cancer. Chin Med J (Engl). 2011; 124:4345–4349.
6. Okada K, Okihara K, Kitamura K, Mikami K, Ukimura O, Kawauchi A, et al. Community-based prostate cancer screening in Japan: predicting factors for positive repeat biopsy. Int J Urol. 2010; 17:541–547.
Article
7. Yoshida T, Nakayama M, Takeda K, Arai Y, Kakimoto K, Nishimura K. External validation of the cancer of the prostate risk assessment score to predict biochemical relapse after radical prostatectomy for prostate cancer in Japanese patients. Urol Int. 2012; 89:45–51.
Article
8. Hyun JS. Prostate cancer and sexual function. World J Mens Health. 2012; 30:99–107.
Article
9. Ro YK, Lee S, Jeong CW, Hong SK, Byun SS, Lee SE. Biochemical recurrence in Gleason score 7 prostate cancer in Korean men: significance of the primary Gleason grade. Korean J Urol. 2012; 53:826–829.
Article
10. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008; 358:1250–1261.
Article
11. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol. 2008; 53:68–80.
Article
12. Mohler JL, Armstrong AJ, Bahnson RR, Boston B, Busby JE, D'Amico AV, et al. Prostate cancer, Version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012; 10:1081–1087.
Article
13. Wilson JR, Clarke MG, Ewings P, Graham JD, MacDonagh R. The assessment of patient life-expectancy: how accurate are urologists and oncologists? BJU Int. 2005; 95:794–798.
Article
14. Froehner M, Koch R, Litz RJ, Hakenberg OW, Wirth MP. Which patients are at the highest risk of dying from competing causes ≤ 10 years after radical prostatectomy? BJU Int. 2012; 110:206–210.
Article
15. Froehner M, Koch R, Litz RJ, Oehlschlaeger S, Hakenberg OW, Wirth MP. Feasibility and limitations of comorbidity measurement in patients undergoing radical prostatectomy. Eur Urol. 2005; 47:190–195.
16. Froehner M, Koch R, Litz RJ, Hakenberg OW, Oehlschlaeger S, Wirth MP. Comorbidity is poor predictor of survival in patients undergoing radical prostatectomy after 70 years of age. Urology. 2006; 68:583–586.
Article
17. Froehner M, Koch R, Litz RJ, Oehlschlaeger S, Twelker L, Hakenberg OW, et al. Detailed analysis of Charlson comorbidity score as predictor of mortality after radical prostatectomy. Urology. 2008; 72:1252–1257.
Article
18. Guzzo TJ, Dluzniewski P, Orosco R, Platz EA, Partin AW, Han M. Prediction of mortality after radical prostatectomy by Charlson comorbidity index. Urology. 2010; 76:553–557.
Article
19. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007; 45:247–251.
Article
20. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993; 46:1075–1079.
Article
21. Heagerty PJ, Zheng Y. Survival model predictive accuracy and ROC curves. Biometrics. 2005; 61:92–105.
Article
22. Albertsen PC, Moore DF, Shih W, Lin Y, Li H, Lu-Yao GL. Impact of comorbidity on survival among men with localized prostate cancer. J Clin Oncol. 2011; 29:1335–1341.
Article
23. Post PN, Hansen BE, Kil PJ, Janssen-Heijnen ML, Coebergh JW. The independent prognostic value of comorbidity among men aged < 75 years with localized prostate cancer: a population-based study. BJU Int. 2001; 87:821–826.
Article
24. Lund L, Borre M, Jacobsen J, Sørensen HT, Nørgaard M. Impact of comorbidity on survival of Danish prostate cancer patients, 1995-2006: a population-based cohort study. Urology. 2008; 72:1258–1262.
Article
25. Briganti A, Spahn M, Joniau S, Gontero P, Bianchi M, Kneitz B, et al. Impact of age and comorbidities on long-term survival of patients with high-risk prostate cancer treated with radical prostatectomy: a multi-institutional competing-risks analysis. Eur Urol. 2013; 63:693–701.
Article
26. Daskivich TJ, Chamie K, Kwan L, Labo J, Dash A, Greenfield S, et al. Comorbidity and competing risks for mortality in men with prostate cancer. Cancer. 2011; 117:4642–4650.
Article
27. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005; 293:2095–2101.
Article
28. Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H. Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer. Asian J Androl. 2009; 11:131–137.
Article
29. Singh GK, Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004; 95:I14–I21.
Article
30. Ebrahim S, Patel N, Coats M, Greig C, Gilley J, Bangham C, et al. Prevalence and severity of morbidity among Gujarati Asian elders: a controlled comparison. Fam Pract. 1991; 8:57–62.
Article
31. Woo EK, Han C, Jo SA, Park MK, Kim S, Kim E, et al. Morbidity and related factors among elderly people in South Korea: results from the Ansan Geriatric (AGE) cohort study. BMC Public Health. 2007; 7:10.
Article
32. Lim S, Park KS, Lee HK, Cho SI. Changes in the characteristics of metabolic syndrome in Korea over the period 1998-2001 as determined by Korean National Health and Nutrition Examination Surveys. Diabetes Care. 2005; 28:1810–1812.
Article
33. Byun SS, Lee S, Lee SE, Lee E, Seo SI, Lee HM, et al. Recent changes in the clinicopathologic features of Korean men with prostate cancer: a comparison with Western populations. Yonsei Med J. 2012; 53:543–549.
Article
34. Kil SR, Lee SI, Khang YH, Lee MS, Kim HJ, Kim SO, et al. Development and validation of comorbidity index in South Korea. Int J Qual Health Care. 2012; 24:391–402.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr