PURPOSE: Accurate estimation of life expectancy is critical for men considering aggressive vs. non-aggressive treatment of early-stage prostate cancer.
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We sought to create an age-adjusted comorbidity index that predicts other-cause mortality in men with prostate cancer.
MATERIALS AND METHODS: We sampled 1,598 men consecutively diagnosed with prostate cancer between 1998 and 2004 at the West Los Angeles and Long Beach Veterans' Affairs Hospitals. We used competing-risks regression in testing and validation cohorts to determine risk of non-prostate-cancer-related (i.e. other-cause) mortality associated with age at diagnosis and prostate-cancer-specific comorbidity index (PCCI) scores. We converted risks into a 10-point scoring system and calculated 2-, 5-, and 10-year cumulative incidence of other-cause mortality by age-adjusted PCCI scores.
RESULTS: PCCI score and age were associated with similar hazards of other-cause mortality in testing and validation cohorts. Each 6-year increase in age at diagnosis over 60 was equivalent to 1 additional PCCI point. After correcting PCCI scores for age, age-adjusted PCCI scores were strongly predictive of other-cause mortality; subhazard ratios for other-cause mortality for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ (vs. 0) were 2.0 (95%CI 1.3-3.0); 4.0 (95%CI 2.6-6.1); 8.7 (95%CI 5.7-13.3); 14.7 (95%CI 9.4-22.8); and 43.2 (95%CI 26.6-70.4), respectively. Ten-year cumulative incidences of other-cause mortality were 10%, 19%, 35%, 60%, 79%, and 99%, respectively.
CONCLUSIONS: The age-adjusted PCCI strongly stratifies risk of long-term, other-cause mortality and may be incorporated into shared decision making to reduce overtreatment of older and sicker men with prostate cancer.
Daskivich TJ, Kwan L, Dash A, Saigal C, Litwin MS. Are you the author?
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Los Angeles, CA; Department of Urology, University of Washington, Seattle, WA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.
Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00171-8.