Accurate assessment of life expectancy (LE) is critical to treatment decision making for men with prostate cancer. We sought to externally validate the Prostate Cancer Comorbidity Index (PCCI) for prediction of long-term mortality in men with prostate cancer and operationalize it using claims data.
We conducted an observational study of 181,009 men with prostate cancer from the Veterans Affairs Health System diagnosed from 2000-2013. Overall mortality across PCCI scores was analyzed using Kaplan-Meier and Cox proportional hazards analysis. Discrimination and calibration were measured using c-index and mean prediction error, respectively.
Among men with PCCI scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+, 10-year overall mortality was 15%, 26%, 36%, 41%, 52%, and 69%, respectively. Multivariable Cox analysis showed an increasing hazard of mortality (95%CI) with higher PCCI scores: 1.22 (1.18-1.27), 1.69 (1.61-1.76), 2.08 (2.00-2.17), 2.88 (2.76-3.00), 4.50 (4.32-4.69) for scores of 1-2, 3-4, 5-6, 7-9, and 10+, respectively. C-index for prediction of overall mortality was 0.773. Mean absolute error for prediction of 10-year overall mortality was 0.032. Among men with clinically localized, Gleason ≤6 disease with LE<10 years and Gleason ≤7 disease with LE<5 years as defined by the PCCI, 3,999/12,185 (33%) and 1,038/3,930 (26%) men were treated with definitive local treatment, respectively.
The PCCI is a claims-based, externally validated tool that predicts mortality in men with prostate cancer. Integration of the PCCI into clinical pathways may improve prostate cancer management through more accurate LE assessment.
The Journal of urology. 2019 Apr 22 [Epub ahead of print]
Timothy J Daskivich, I-Chun Thomas, Michael Luu, Jeremy B Shelton, Danil V Makarov, Ted A Skolarus, John T Leppert
Division of Urology, Cedars-Sinai Medical Center , Los Angeles , CA., VA Palo Alto Health Care System , Palo Alto , CA., Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center , Los Angeles , CA., Department of Urology, UCLA, Los Angeles, CA; West Los Angeles VA Medical Center , Los Angeles , CA., Departments of Urology and Population Health, New York University Langone Medical Center, New York, New York: Veterans Affairs New York Harbor Healthcare System , New York , New York., Department of Urology, University of Michigan: VA Ann Arbor Healthcare System, Center for Clinical Management and Research.