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

  • Ho Won Kang
  • Sung Min Kim
  • Won Tae Kim
  • Seok Joong Yun
  • Sang-Cheol Lee
  • Wun-Jae Kim
  • Eu Chang Hwang
  • Seok Ho Kang
  • Sung-Hoo Hong
  • Jinsoo Chung
  • Tae Gyun Kwon
  • Hyeon Hoe Kim
  • Cheol Kwak
  • Seok-Soo ByunEmail author
  • Yong-June KimEmail author
  • The KORCC (KOrean Renal Cell Carcinoma) Group
Original Article – Clinical Oncology



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).


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.


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.


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


Renal cell carcinoma Nephrectomy Comorbidity Prognosis Survival 


Author 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.


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).

Compliance with ethical standards

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.

Informed consent

Informed consent was waived by the board.

Supplementary material

432_2019_3042_MOESM1_ESM.jpg (455 kb)
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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyChungbuk National University College of MedicineCheongjuSouth Korea
  2. 2.Department of UrologyChungbuk National University HospitalCheongjuSouth Korea
  3. 3.Department of UrologyChonnam National University Hwasun HospitalHwasunSouth Korea
  4. 4.Department of UrologyKorea University School of MedicineSeoulSouth Korea
  5. 5.Department of Urology, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  6. 6.Department of UrologyNational Cancer CenterGoyangSouth Korea
  7. 7.Department of UrologyKyungpook National University College of MedicineDaeguSouth Korea
  8. 8.Department of UrologySeoul National University College of MedicineSeoulSouth Korea
  9. 9.Department of UrologySeoul National University Bundang HospitalSeongnamSouth Korea

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