BERKELEY, CA (UroToday Inc.) - The Charlson score provides a means of assessing comorbidity and overall mortality by accounting for the presence or absence of nineteen different conditions that are scored and summed. The presence of conditions such as myocardial infarction, congestive heart failure (CHF), peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, diabetes and others are tabulated. The patient is then classified into a Charlson class.

A total of 444 consecutive patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the study reported by Dr. Froehner and his associates from Germany in the February, 2004 issue of the Journal of Urology. The patients were followed for a mean of 5.9 years and mortality was assessed and classified as resulting from prostate cancer or from a cormorbid condition.

There were fifty-four deaths from any cause in the follow-up period and these were considered events concerning overall survival. Eighteen deaths were considered to be the result of uncontrolled prostate cancer. Twenty-four deaths occurred in the absence of cancer or by accident and were considered events concerning comorbidity-specific survival. Other deaths occurred from non-co-morbid conditions such as cancer of other organs.

Only eight of the nineteen conditions of the Charlson scoring system were associated with any mortality in this radical prostatectomy series. These conditions were myocardial infarction, CHF, peripheral vascular disease, chronic pulmonary disease, ulcer disease, diabetes, significant renal dysfunction and diabetes with end organ damage. Only four conditions - CHF, peripheral vascular disease, chronic pulmonary disease and moderate or severe renal disease were found to be statistically significant.

This study suggests that restricting the Charlson score to these clinically meaningful diseases may increase its usefulness in choosing candidates for radical prostatectomy. Although it is based on a great variety of diseases, the conventional Charlson score added little clinical information especially patients with congestive heart failure, which was the single most important co-morbid condition. Nevertheless, the authors suggest that additional studies must confirm that the 4 co-morbid diseases identified in their observations have importance in assigning risk to patients undergoing radical prostatectomy.

J Urol. 2004; 171:697-9