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Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients

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Abstract

Introduction

Cancer survival is related not only to primary malignancy but also to concomitant nonmalignant diseases. The aim of this study was to investigate the prognostic capacity of four comorbidity indices [the Charlson comorbidity index (CCI), the Elixhauser method, the National Institute on Aging (NIA) and National Cancer Institute (NCI) comorbidity index, and the Adult Comorbidity Evaluation-27 (ACE-27)] for both cancer-related and all-cause mortality among colorectal cancer patients. A modified version of the CCI adapted for colorectal cancer patients was also built.

Methods

The study population comprised 468 cases of colorectal cancer diagnosed between 1 January 2000 and 31 December 2010 at a community hospital. Data were prospectively collected and abstracted from patients’ clinical records. Kaplan-Meier method and multivariate logistic regression models were performed for survival and risk of death analysis.

Results

Only moderate or severe renal disease [hazard ratio (HR) 2.71, 95 % confidence interval (CI) 1.11–6.63] and AIDS (HR 3.27, 95 % CI 1.23–8.68) were independently associated with cancer-specific mortality, with a population attributable risk of 5.18 and 4.36 %, respectively. For each index, the highest comorbidity burden was significantly associated with poorer overall survival (NIA/NCI: HR 2.14, 95 % CI 1.14–4.01; Elixhauser: HR 1.98, 95 % CI 1.09–1.42; ACE-27: HR 1.78, 95 % CI 1.07–1.23; CCI: HR 1.68, 95 % CI 1.05–1.42) and cancer-specific survival. The modified version of the CCI resulted in a higher predictive power compared with other indices studied (cancer-specific mortality HR = 2.37, 95 % CI 1.37–4.08).

Conclusions

The comorbidity assessment tools provided better prognostic prevision of prospective outcome of colorectal cancer patients than single comorbid conditions.

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References

  1. Haggar FA, Boushey RP (2009) Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 22:191–197. doi:10.1055/s-0029-1242458

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisener MP, Reichman M, Edwards BK (2008) SEER Cancer Statistics Review, 1975-2005: Bethesda

  3. Biondi A, Grosso G, Mistretta A, Marventano S, Toscano C, Gruttadauria S, Basile F (2013) Laparoscopic-assisted versus open surgery for colorectal cancer: short-and long-term outcomes comparison. J Laparoendosc Adv Surg Tech A 23:1–7. doi:10.1089/lap.2012.0276

    Article  PubMed Central  PubMed  Google Scholar 

  4. Biondi A, Grosso G, Mistretta A, Marventano S, Tropea A, Gruttadauria S, Basile F (2014) Predictors of conversion in laparoscopic-assisted colectomy for colorectal cancer and clinical outcomes. Surg Laparosc Endosc Percutan Tech 24:e21–e26. doi:10.1097/SLE.0b013e31828f6bc0

    Article  PubMed  Google Scholar 

  5. Grosso G, Biondi A, Marventano S, Mistretta A, Calabrese G, Basile F (2012) Major postoperative complications and survival for colon cancer elderly patients. BMC Surg 12(Suppl 1):S20. doi:10.1186/1471-2482-12-S1-S20

    Article  PubMed Central  PubMed  Google Scholar 

  6. Tan KY, Kawamura Y, Mizokami K, Sasaki J, Tsujinaka S, Maeda T, Konishi F (2009) Colorectal surgery in octogenarian patients—outcomes and predictors of morbidity. Int J Colorectal Dis 24:185–189. doi:10.1007/s00384-008-0615-9

    Article  CAS  PubMed  Google Scholar 

  7. Yun HR, Lee WY, Lee WS, Cho YB, Yun SH, Chun HK (2007) The prognostic factors of stage IV colorectal cancer and assessment of proper treatment according to the patient's status. Int J Colorectal Dis 22:1301–1310

    Article  PubMed  Google Scholar 

  8. Kim J, Konyalian V, Huynh R, Mittal R, Stamos M, Kumar R (2007) Identification of predictive factors for perioperative blood transfusion in colorectal resection patients. Int J Colorectal Dis 22:1493–1497

    Article  PubMed  Google Scholar 

  9. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, Chin CC (2011) Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis 26:473–481. doi:10.1007/s00384-010-1113-4

    Article  PubMed  Google Scholar 

  10. Van Leersum NJ, Janssen-Heijnen ML, Wouters MW, Rutten HJ, Coebergh JW, Tollenaar RA, Lemmens VE (2013) Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995-2010. Int J Cancer 132:2157–2163. doi:10.1002/ijc.27871

    Article  PubMed  Google Scholar 

  11. Hines RB, Shanmugam C, Waterbor JW, McGwin G Jr, Funkhouser E, Coffey CS, Posey J, Manne U (2009) Effect of comorbidity and body mass index on the survival of African-American and Caucasian patients with colon cancer. Cancer 115:5798–5806. doi:10.1002/cncr.24598

    Article  PubMed Central  PubMed  Google Scholar 

  12. Iversen LH, Norgaard M, Jacobsen J, Laurberg S, Sorensen HT (2009) The impact of comorbidity on survival of Danish colorectal cancer patients from 1995 to 2006—a population-based cohort study. Dis Colon Rectum 52:71–78. doi:10.1007/DCR.0b013e3181974384

    Article  PubMed  Google Scholar 

  13. Lemmens VE, Janssen-Heijnen ML, Verheij CD, Houterman S, Repelaer van Driel OJ, Coebergh JW (2005) Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg 92:615–623

    Article  CAS  PubMed  Google Scholar 

  14. Gross CP, Guo Z, McAvay GJ, Allore HG, Young M, Tinetti ME (2006) Multimorbidity and survival in older persons with colorectal cancer. J Am Geriatr Soc 54:1898–1904

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  16. Reid BC, Alberg AJ, Klassen AC, Koch WM, Samet JM (2001) The American Society of Anesthesiologists’ class as a comorbidity index in a cohort of head and neck cancer surgical patients. Head Neck 23:985–994

    Article  CAS  PubMed  Google Scholar 

  17. Pasternak I, Dietrich M, Woodman R, Metzger U, Wattchow DA, Zingg U (2010) Use of severity classification systems in the surgical decision-making process in emergency laparotomy for perforated diverticulitis. Int J Colorectal Dis 25:463–470. doi:10.1007/s00384-009-0852-6

    Article  PubMed  Google Scholar 

  18. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

  19. Piccirillo JF (2000) Importance of comorbidity in head and neck cancer. Laryngoscope 110:593–602

    Article  CAS  PubMed  Google Scholar 

  20. Havlik RJ, Yancik R, Long S, Ries L, Edwards B (1994) The National Institute on Aging and the National Cancer Institute SEER collaborative study on comorbidity and early diagnosis of cancer in the elderly. Cancer 74:2101–2106

    Article  CAS  PubMed  Google Scholar 

  21. Yancik R, Wesley MN, Ries LA, Havlik RJ, Long S, Edwards BK, Yates JW (1998) Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 82:2123–2134

    Article  CAS  PubMed  Google Scholar 

  22. Lieffers JR, Baracos VE, Winget M, Fassbender K (2011) A comparison of Charlson and Elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data. Cancer 117:1957–1965. doi:10.1002/cncr.25653

    Article  PubMed  Google Scholar 

  23. Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G (2006) In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care 44:745–753

    Article  PubMed  Google Scholar 

  24. Hines RB, Chatla C, Bumpers HL, Waterbor JW, McGwin G Jr, Funkhouser E, Coffey CS, Posey J, Manne U (2009) Predictive capacity of three comorbidity indices in estimating mortality after surgery for colon cancer. J Clin Oncol 27:4339–4345. doi:10.1200/JCO.2009.22.4758

    Article  PubMed Central  PubMed  Google Scholar 

  25. National Institutes of Health (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report

  26. Green FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG (2002) American Joint Committee on Cancer. AJCC Cancer Staging Manual, London

    Google Scholar 

  27. Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 88:1739–1757

    Article  CAS  PubMed  Google Scholar 

  28. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291:2441–2447

    Article  CAS  PubMed  Google Scholar 

  29. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  30. Read WL, Tierney RM, Page NC, Costas I, Govindan R, Spitznagel EL, Piccirillo JF (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22:3099–3103

    Article  PubMed  Google Scholar 

  31. Rametta S, Grosso G, Galvano F, Mistretta A, Marventano S, Nolfo F, Buscemi S, Gangi S, Basile F, Biondi A (2013) Social disparities, health risk behaviors, and cancer. BMC Surg 13(Suppl 2):S17. doi:10.1186/1471-2482-13-S2-S17

    Article  PubMed Central  PubMed  Google Scholar 

  32. Sarfati D, Hill S, Blakely T, Robson B, Purdie G, Dennett E, Cormack D, Dew K (2009) The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study. BMC Cancer 9:116. doi:10.1186/1471-2407-9-116

    Article  PubMed Central  PubMed  Google Scholar 

  33. Kieszak SM, Flanders WD, Kosinski AS, Shipp CC, Karp H (1999) A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol 52:137–142

    Article  CAS  PubMed  Google Scholar 

  34. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 56:221–229

    Article  PubMed  Google Scholar 

  35. Ouellette JR, Small DG, Termuhlen PM (2004) Evaluation of Charlson-Age Comorbidity Index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 8:1061–1067

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Giuseppe Grosso was supported by the International Ph.D. Program in Neuropharmacology, University of Catania Medical School, Catania, Italy. The funders had no role in the study.

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Authors and Affiliations

  1. Department “G. F. Ingrassia,” Section of Hygiene and Public Health, University of Catania, Catania, Italy

    Stefano Marventano, Giuseppe Grosso, Antonio Mistretta, Roberta Ferranti, Francesca Nolfo, Gabriele Giorgianni & Stefania Rametta

  2. Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy

    Giuseppe Grosso & Filippo Drago

  3. Cancer Diagnosis and Treatment Center, Katowice, Silesian District, Poland

    Marta Bogusz-Czerniewicz

  4. Department of General Surgery, Section of General Surgery and Oncology, University of Catania, Catania, Italy

    Francesco Basile & Antonio Biondi

  5. Department of General Surgery, Section of General Surgery and Oncology, University Medical School of Catania, Catania, Italy

    Antonio Biondi

Authors
  1. Stefano Marventano
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  2. Giuseppe Grosso
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  3. Antonio Mistretta
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  10. Francesco Basile
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  11. Antonio Biondi
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Correspondence to Antonio Biondi.

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Marventano, S., Grosso, G., Mistretta, A. et al. Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients. Int J Colorectal Dis 29, 1159–1169 (2014). https://doi.org/10.1007/s00384-014-1972-1

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