Skip to main content

Advertisement

SpringerLink
Log in

Age-adjusted Charlson comorbidity index is a significant prognostic factor for long-term survival of patients with high-risk prostate cancer after radical prostatectomy: a Bayesian model averaging approach

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We investigated the long-term prognostic impact of age-adjusted Charlson comorbidity index (ACCI) on overall mortality (OM), cancer-specific mortality (CSM), and other-cause mortality (OCM) according to risk stratification in patients with prostate cancer who underwent radical prostatectomy.

Methods

Data from 542 patients who underwent radical prostatectomy between 1992 and 2006 were analyzed. The impact of preoperative variables including age, prostate-specific antigen, biopsy Gleason sum, clinical stage, and ACCI on OM, CSM, and OCM were analyzed according to risk groups, with a median follow-up of 101 months.

Results

Subjects were stratified into either the high-risk group (n = 241) or the non-high-risk group (n = 301). Cox proportional hazards model demonstrated that the ACCI was the only significant predictor for OM in all patients (hazard ratio, HR 1.41; 95 % confidence interval, CI 1.19–1.66), non-high-risk group (HR 1.45; 95 % CI 1.09–1.91), and high-risk group (HR 1.37; 95 % CI 1.11–1.69). In competing risk analysis, CSM was not associated with the ACCI in either risk group. However, the ACCI had a significant impact on OCM in both the non-high-risk (HR 1.55; 95 % CI 1.16–2.1) and high-risk groups (HR 1.60; 95 % CI 1.23–2.08). A Bayesian model averaging approach verified that the ACCI was the most powerful predictor for OM and OCM in the both high-risk and non-high-risk groups.

Conclusions

A thorough assessment of comorbidities is mandatory in establishing prognoses, even when considering invasive treatment modalities in high-risk prostate cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abdollah F, Suardi N, Cozzarini C et al (2013) Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis. Eur Urol 63(6):998–1008

    Article  PubMed  Google Scholar 

  • Adolfsson J, Steineck G, Hedlund PO (1999) Deferred treatment of locally advanced nonmetastatic prostate cancer: a long-term followup. J Urol 161(2):505–508

    Article  CAS  PubMed  Google Scholar 

  • Bastide C, Rossi D, Lechevallier E et al (2012) Seminal vesicle invasion: what is the best adjuvant treatment after radical prostatectomy? BJU Int 109(4):525–530 discussion 531–522

    Article  PubMed  Google Scholar 

  • Berry DA (2006) Bayesian clinical trials. Nat Rev Drug Discov 5(1):27–36

    Article  CAS  PubMed  Google Scholar 

  • Boorjian SA, Karnes RJ, Viterbo R, Rangel LJ, Bergstralh EJ, Horwitz EM, Blute ML, Buyyounouski MK (2011) Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer 117(13):2883–2891

    Article  PubMed  PubMed Central  Google Scholar 

  • Borza T, Kibel AS (2014) Local treatment of high risk prostate cancer: role of surgery and radiation therapy. Cancer 120(11):1608–1610

    Article  PubMed  Google Scholar 

  • Bradley CJ, Dahman B, Anscher M (2014) Prostate cancer treatment and survival: evidence for men with prevalent comorbid conditions. Med Care 52(6):482–489

    Article  PubMed  PubMed Central  Google Scholar 

  • Briganti A, Spahn M, Joniau S et al (2012) 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 63(4):693–701

    Article  PubMed  Google Scholar 

  • Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251

    Article  CAS  PubMed  Google Scholar 

  • Cooperberg MR, Vickers AJ, Broering JM, Carroll PR (2010) Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer 116(22):5226–5234

    Article  PubMed  PubMed Central  Google Scholar 

  • Daskivich TJ, Chamie K, Kwan L, Labo J, Dash A, Greenfield S, Litwin MS (2011a) Comorbidity and competing risks for mortality in men with prostate cancer. Cancer 117(20):4642–4650

    Article  PubMed  Google Scholar 

  • Daskivich TJ, Chamie K, Kwan L, Labo J, Dash A, Greenfield S, Litwin MS (2011b) Improved prediction of long-term, other cause mortality in men with prostate cancer. J Urol 186(5):1868–1873

    Article  PubMed  Google Scholar 

  • Daskivich TJ, Kwan L, Dash A, Greenfield S, Litwin MS (2014a) Weighted versus unweighted charlson score to predict long-term other-cause mortality in men with early-stage prostate cancer. Eur Urol 66(6):1002–1009

    Article  PubMed  Google Scholar 

  • Daskivich TJ, Lai J, Dick AW, Setodji CM, Hanley JM, Litwin MS, Saigal C (2014b) Comparative effectiveness of aggressive versus nonaggressive treatment among men with early-stage prostate cancer and differing comorbid disease burdens at diagnosis. Cancer 120(16):2432–2439

    Article  PubMed  Google Scholar 

  • Daskivich TJ, Fan KH, Koyama T et al (2015a) Prediction of long-term other-cause mortality in men with early-stage prostate cancer: results from the prostate cancer outcomes study. Urology 85(1):92–100

    Article  PubMed  PubMed Central  Google Scholar 

  • Daskivich TJ, Kwan L, Dash A, Saigal C, Litwin MS (2015b) An age-adjusted comorbidity index for prediction of long-term, other-cause mortality in men with prostate cancer. J Urol. doi:10.1016/j.juro.2015.01.081

    PubMed  Google Scholar 

  • de Camargo Cancela M, Comber H, Sharp L (2013) Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study. Br J Cancer 109(1):272–279

    Article  Google Scholar 

  • Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  • Froehner M, Kellner AE, Koch R, Baretton GB, Hakenberg OW, Wirth MP (2014a) A combined index to classify prognostic comorbidity in candidates for radical prostatectomy. BMC Urol 14:28

    Article  PubMed  PubMed Central  Google Scholar 

  • Froehner M, Koch R, Hubler M, Litz R, Wirth MP (2014b) Testing of a novel easy-to-use mortality index in a radical prostatectomy cohort. Urology 84(2):307–312

    Article  PubMed  Google Scholar 

  • Gaynor JJ, Feuer EJ, Tan CC, Wu DH, Little CR, Straus DJ, Clarkson BD, Brennan MF (1993) On the use of cause-specific failure and conditional failure probabilities: examples from clinical oncology data. J Am Stat Assoc 88(422):400–409

    Article  Google Scholar 

  • Godtman RA, Holmberg E, Khatami A, Stranne J, Hugosson J (2013) Outcome following active surveillance of men with screen-detected prostate cancer. Results from the Goteborg randomised population-based prostate cancer screening trial. Eur Urol 63(1):101–107

    Article  PubMed  Google Scholar 

  • Goldberg H, Baniel J, Yossepowitch O (2013) Defining high-risk prostate cancer. Curr Opin Urol 23(4):337–341

    Article  PubMed  Google Scholar 

  • Hayes JH, Ollendorf DA, Pearson SD, Barry MJ, Kantoff PW, Lee PA, McMahon PM (2013) Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann Intern Med 158(12):853–860

    Article  PubMed  PubMed Central  Google Scholar 

  • Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80

    Article  PubMed  Google Scholar 

  • Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137

    Article  PubMed  Google Scholar 

  • Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H (2007) Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience. Eur Urol 51(1):121–128 (discussion 128-129)

    Article  PubMed  Google Scholar 

  • Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ (2006) Cancer statistics. CA Cancer J Clin 56(2):106–130

    Article  PubMed  Google Scholar 

  • Kang HW, Lee JY, Kwon JK, Jeh SU, Jung HD, Choi YD (2014) Current status of radical prostatectomy for high-risk prostate cancer. Korean J Urol 55(10):629–635

    Article  PubMed  PubMed Central  Google Scholar 

  • Kibel AS, Ciezki JP, Klein EA et al (2012) Survival among men with clinically localized prostate cancer treated with radical prostatectomy or radiation therapy in the prostate specific antigen era. J Urol 187(4):1259–1265

    Article  PubMed  Google Scholar 

  • Kim IK, Lee JY, Kwon JK, Park JJ, Cho KS, Ham WS, Hong SJ, Yang SC, Choi YD (2014) Prognostic factors for urachal cancer: a bayesian model-averaging approach. Korean J Urol 55(9):574–580

    Article  PubMed  PubMed Central  Google Scholar 

  • Koie T, Ohyama C, Yamamoto H et al (2014) Both radical prostatectomy following treatment with neoadjuvant LHRH agonist and estramustine and radiotherapy following treatment with neoadjuvant hormonal therapy achieved favorable oncological outcome in high-risk prostate cancer: a propensity-score matching analysis. World J Surg Oncol 12:134

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee JW, Ryu JH, Kim YB, Yang SO, Lee JK, Jung TY (2013) Do positive surgical margins predict biochemical recurrence in all patients without adjuvant therapy after radical prostatectomy? Korean J Urol 54(8):510–515

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee JY, Cho KS, Kwon JK, Jeh SU, Kang HW, Diaz RR, Ham WS, Koom WS, Keum KC, Choi YD (2014a) A competing risk analysis of cancer-specific mortality of initial treatment with radical prostatectomy versus radiation therapy in clinically localized high-risk prostate cancer. Ann Surg Oncol 21(12):4026–4033

    Article  PubMed  Google Scholar 

  • Lee JY, Lee DH, Cho NH, Rha KH, Choi YD, Hong SJ, Yang SC, Cho KS (2014b) Charlson comorbidity index is an important prognostic factor for long-term survival outcomes in korean men with prostate cancer after radical prostatectomy. Yonsei Med J 55(2):316–323

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee JY, Lee DH, Cho NH, Rha KH, Choi YD, Hong SJ, Yang SC, Cho KS (2014c) Impact of charlson comorbidity index varies by age in patients with prostate cancer treated by radical prostatectomy: a competing risk regression analysis. Ann Surg Oncol 21(2):677–683

    Article  PubMed  Google Scholar 

  • Lee D, Choi SK, Park J, Shim M, Kim A, Lee S, Song C, Ahn H (2015) Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer. Korean. J Urol 56(8):572–579

    Google Scholar 

  • Merino T, San Francisco IF, Rojas PA, Bettoli P, Zuniga A, Besa P (2013) Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up. BMC Cancer 13:530

    Article  PubMed  PubMed Central  Google Scholar 

  • Mohler JL, Armstrong AJ, Bahnson RR et al (2012) Prostate cancer, version 3.2012 featured updates to the NCCN guidelines. J Natl Compr Canc Netw 10(9):1081–1087

    CAS  PubMed  Google Scholar 

  • Moltzahn F, Karnes J, Gontero P et al (2014) Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients. Prostate Cancer Prostatic Dis 18(1):31–37

    Article  PubMed  Google Scholar 

  • Nieder C, Dalhaug A, Pawinski A, Aandahl G, Norum J (2011) Comorbidity, use of common medications, and risk of early death in patients with localized or locally advanced prostate cancer. In: The Scientific World Journal. pp 1178–1186

  • Petrelli F, Vavassori I, Coinu A, Borgonovo K, Sarti E, Barni S (2014) Radical prostatectomy or radiotherapy in high-risk prostate cancer: a systematic review and metaanalysis. Clin Genitourin Cancer 12(4):215–224

    Article  PubMed  Google Scholar 

  • Ravi P, Karakiewicz PI, Roghmann F et al (2014) Mental health outcomes in elderly men with prostate cancer. Urol Oncol 32(8):1333–1340

    Article  PubMed  Google Scholar 

  • Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46(10):1075–1079 discussion 1081-1090

    Article  CAS  PubMed  Google Scholar 

  • Sanda MG, Dunn RL, Michalski J et al (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261

    Article  CAS  PubMed  Google Scholar 

  • Siddiqui SA, Boorjian SA, Blute ML, Rangel LJ, Bergstralh EJ, Karnes RJ, Frank I (2011) Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer. BJU Int 107(3):383–388

    Article  PubMed  Google Scholar 

  • Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, Menon M (2007) Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy–a propensity scoring approach. J Urol 177(3):911–915

    Article  PubMed  Google Scholar 

  • Thompson I, Thrasher JB, Aus G et al (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177(6):2106–2131

    Article  PubMed  Google Scholar 

  • Van Hemelrijck M, Folkvaljon Y, Adolfsson J, Akre O, Holmberg L, Garmo H, Stattin P (2015) Causes of death in men with localised prostate cancer: a nationwide, population-based study. BJU Int. doi:10.1111/bju.13059

    Google Scholar 

  • Van Poppel H, Joniau S (2008) An analysis of radical prostatectomy in advanced stage and high-grade prostate cancer. Eur Urol 53(2):253–259

    Article  PubMed  Google Scholar 

  • Westover K, Chen MH, Moul J, Robertson C, Polascik T, Dosoretz D, Katin M, Salenius S, D’Amico AV (2012) Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer. BJU Int 110(8):1116–1121

    Article  PubMed  Google Scholar 

  • Yossepowitch O, Eggener SE, Bianco FJ Jr, Carver BS, Serio A, Scardino PT, Eastham JA (2007) Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol 178(2):493–499 (discussion 499)

    Article  PubMed  Google Scholar 

  • Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, Vickers A, Scardino PT (2010) Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol 28(9):1508–1513

    Article  PubMed  PubMed Central  Google Scholar 

  • Zumsteg ZS, Zelefsky MJ (2013) Improved survival with surgery in prostate cancer patients without medical comorbidity: a self-fulfilling prophecy? Eur Urol 64(3):381–383

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a Grant from the Korean Foundation for Cancer Research (CB-2011-04-02), Republic of Korea.

Author information

Authors and Affiliations

  1. Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

    Joo Yong Lee, Koon Ho Rha, Young Deuk Choi & Sung Joon Hong

  2. Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea

    Ho Won Kang

  3. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Nam Hoon Cho

  4. Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea

    Kang Su Cho

Authors
  1. Joo Yong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ho Won Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koon Ho Rha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nam Hoon Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young Deuk Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sung Joon Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kang Su Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kang Su Cho.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent given by participants was exempted because of the retrospective study design and patients records, and information was anonymized and de-identified prior to analysis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.Y., Kang, H.W., Rha, K.H. et al. Age-adjusted Charlson comorbidity index is a significant prognostic factor for long-term survival of patients with high-risk prostate cancer after radical prostatectomy: a Bayesian model averaging approach. J Cancer Res Clin Oncol 142, 849–858 (2016). https://doi.org/10.1007/s00432-015-2093-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-015-2093-0

Keywords

Search

Navigation