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The age-adjusted Charlson comorbidity index as a predictor of overall survival of surgically treated non-metastatic clear cell renal cell carcinoma

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

No study has evaluated the prognostic impact of the age-adjusted Charlson comorbidity index (AACI) in those with renal cell carcinoma (RCC). This study aimed to evaluate the utility of the AACI for predicting long-term survival in patients with surgically treated non-metastatic clear cell RCC (ccRCC).

Methods

Data from 698 patients with non-metastatic ccRCC who underwent radical or partial nephrectomy as primary therapy from a multi-institutional Korean collaboration between 1988 and 2015 were retrospectively analyzed. Clinicopathological variables and survival outcomes of those with AACI scores ≤ 3 (n = 324), 4–5 (n = 292), and ≥ 6 (n = 82) were compared.

Results

Patients with a high AACI score were older and more likely to be female. They were also more likely to have diabetes or hypertension, a worse Eastern Cooperative Oncology Group performance status, and lower preoperative hemoglobin, albumin, serum calcium, and serum total cholesterol levels. Regarding pathologic features, a high AACI score was associated with advanced stage. Kaplan–Meier analyses revealed that AACI ≥ 6 was associated with shorter cancer-specific (log-rank test, P < 0.001) and overall survival (log-rank test, P < 0.001), but not with recurrence-free survival (log-rank test, P = 0.134). Multivariate Cox regression analyses identified an AACI score as an independent predictor of overall survival (hazard ratio, 6.870; 95% confidence interval, 2.049–23.031; P = 0.002). The AACI score was a better discriminator of overall survival than the Charlson comorbidity index score.

Conclusions

AACI scores may enable more tailored, individualized management strategies for patients with surgically treated non-metastatic ccRCC.

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References

  • Ather MH, Nazim SM (2010) Impact of Charlson’s comorbidity index on overall survival following tumor nephrectomy for renal cell carcinoma. Int Urol Nephrol 42:299–303

    Article  Google Scholar 

  • Aziz A et al (2014) Comparative analysis of comorbidity and performance indices for prediction of oncological outcomes in patients with upper tract urothelial carcinoma who were treated with radical nephroureterectomy. Urol Oncol Semin Orig Investig 8:1141–1150

    Article  Google Scholar 

  • Berger DA et al (2008) Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology 72:359–363

    Article  Google Scholar 

  • Chang C-M, Yin W-Y, Wei C-K, Wu C-C, Su Y-C, Yu C-H, Lee C-C (2016) Adjusted age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery. PLoS One 11:e0148076

    Article  Google Scholar 

  • de Cássio Zequi S, de Campos EC, Guimarães GC, Bachega W Jr, da Fonseca FP, Lopes A (2010) The use of the American Society of Anesthesiology Classification as a prognostic factor in patients with renal cell carcinoma. Urol Int 84:67–72

    Article  Google Scholar 

  • Dias-Santos D, Ferrone CR, Zheng H, Lillemoe KD, Fernández-del Castillo C (2015) The Charlson age comorbidity index predicts early mortality after surgery for pancreatic cancer. Surgery 157:881–887

    Article  Google Scholar 

  • Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  Google Scholar 

  • Escudier B et al (2016) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 27:v58–v68

    Article  CAS  Google Scholar 

  • Extermann M (2000) Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol 35:181–200

    Article  CAS  Google Scholar 

  • Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663

    Article  CAS  Google Scholar 

  • Gettman MT, Boelter CW, Cheville JC, Zincke H, Bryant SC, Blute ML (2003) Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol 169:1282–1286

    Article  Google Scholar 

  • Ho CH, Chen YC, Chu CC, Wang JJ, Liao KM (2017) Age-adjusted Charlson comorbidity score is associated with the risk of empyema in patients with COPD. Medicine 96:e8040. https://doi.org/10.1097/md.0000000000008040

    Article  PubMed  PubMed Central  Google Scholar 

  • Islam KM, Jiang X, Anggondowati T, Lin G, Ganti AK (2015) Comorbidity and survival in lung cancer patients. Cancer Epidemiol Prev Biomark 24:1079–1085

    Article  Google Scholar 

  • Kang HW et al (2016) Impact of young age at diagnosis on survival in patients with surgically treated renal cell carcinoma: a multicenter study. J Korean Med Sci 31:1976–1982

    Article  Google Scholar 

  • Kang HW et al (2017) Impact of the ASA physical status score on adjuvant chemotherapy eligibility and survival of upper tract urothelial carcinoma patients: a multicenter study. J Korean Med Sci 32:335–342

    Article  Google Scholar 

  • King SC, Pollack LA, Li J, King JB, Master VA (2014) Continued increase in incidence of renal cell carcinoma, especially in young patients and high grade disease: United States 2001 to 2010. J Urol 191:1665–1670

    Article  Google Scholar 

  • Ko K, Park YH, Lee JW, Ku JH, Kwak C, Kim HH (2013) Influence of nutritional deficiency on prognosis of renal cell carcinoma (RCC). BJU Int 112:775–780

    Article  CAS  Google Scholar 

  • Koppie TM et al (2008) Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer Interdiscipl Int J Am Cancer Soc 112:2384–2392

    Google Scholar 

  • Ljungberg B et al (2019) European Association of Urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75:799–810

    Article  Google Scholar 

  • Lund L, Jacobsen J, Nørgaard M, McLaughlin JK, Blot WJ, Borre M, Sørensen HT (2009) The prognostic impact of comorbidities on renal cancer, 1995 to 2006: a Danish population based study. J Urol 182:35–40

    Article  Google Scholar 

  • Motzer RJ et al (2017) Kidney cancer, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 15:804–834

    Article  Google Scholar 

  • Park JW et al (2018) Age-adjusted Charlson comorbidity index as a prognostic factor for radical prostatectomy outcomes of very high-risk prostate cancer patients. PLoS One 13:e0199365

    Article  Google Scholar 

  • Robbins JR, Gayar OH, Zaki M, Mahan M, Buekers T, Elshaikh MA (2013) Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer. Gynecol Oncol 131:593–597

    Article  Google Scholar 

  • Santos Arrontes D, Fernandez Acenero MJ, Garcia Gonzalez JI, Martin Munoz M, Paniagua Andres P (2008) Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index. J Urol 179:857–861

    Article  Google Scholar 

  • Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M (2013) The impact of comorbidity on cancer survival: a review. Clin Epidemiol 5:3

    Article  Google Scholar 

  • Suidan RS et al (2015) Predictive value of the age-adjusted Charlson comorbidity index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer. Gynecol Oncol 138:246–251

    Article  Google Scholar 

  • Verhoest G et al (2007) Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol 51:1298–1305

    Article  Google Scholar 

  • Wu C-C, Hsu T-W, Chang C-M, Yu C-H, Lee C-C (2015) Age-adjusted Charlson comorbidity index scores as predictor of survival in colorectal cancer patients who underwent surgical resection and chemoradiation. Medicine 94:e431

    Article  CAS  Google Scholar 

  • Zheng Y, Bao L, Wang W, Wang Q, Pan Y, Gao X (2018) Prognostic impact of the Controlling Nutritional Status score following curative nephrectomy for patients with renal cell carcinoma. Medicine 97:e13409

    Article  Google Scholar 

  • Zisman A et al (2001) Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol 19:1649–1657

    Article  CAS  Google Scholar 

Download references

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2018R1D1A1B07043906).

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Authors and Affiliations

  1. Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea

    Ho Won Kang, Sung Min Kim, Won Tae Kim, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim & Yong-June Kim

  2. Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea

    Ho Won Kang, Won Tae Kim, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim & Yong-June Kim

  3. Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, South Korea

    Eu Chang Hwang

  4. Department of Urology, Korea University School of Medicine, Seoul, South Korea

    Seok Ho Kang

  5. Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Sung-Hoo Hong

  6. Department of Urology, National Cancer Center, Goyang, South Korea

    Jinsoo Chung

  7. Department of Urology, Kyungpook National University College of Medicine, Daegu, South Korea

    Tae Gyun Kwon

  8. Department of Urology, Seoul National University College of Medicine, Seoul, South Korea

    Hyeon Hoe Kim & Cheol Kwak

  9. Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Kyunggi-do, 463-707, South Korea

    Seok-Soo Byun

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  1. Ho Won Kang
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Consortia

The KORCC (KOrean Renal Cell Carcinoma) Group

Contributions

Conception and study design: HWK and YJK. Acquisition of data: SMK, WTK, and SJY. Statistical analysis: SMK, WTK and SJY. Drafting and writing of the manuscript: HWK. Revision and critical review of the manuscript: S-CL, W-JK, ECH, SHK, S-HH, JC, TGK, HHK, CK, S-SB, and Y-JK. Manuscript approval: all authors.

Corresponding authors

Correspondence to Seok-Soo Byun or Yong-June Kim.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the relevant institutional review boards of the eight participating centers, and informed consent was waived by the board.

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Informed consent was waived by the board.

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432_2019_3042_MOESM1_ESM.jpg

Supplementary material 1 Supplementary Fig. Kaplan–Meier survival curves showing (a) cancer-specific survival, and (b) overall survival according to pathologic T stages (pT < 2 vs. ≥ 2) (JPEG 454 kb)

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Kang, H.W., Kim, S.M., Kim, W.T. et al. The age-adjusted Charlson comorbidity index as a predictor of overall survival of surgically treated non-metastatic clear cell renal cell carcinoma. J Cancer Res Clin Oncol 146, 187–196 (2020). https://doi.org/10.1007/s00432-019-03042-7

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  • DOI: https://doi.org/10.1007/s00432-019-03042-7

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