An age-adjusted comorbidity index for prediction of long-term, other-cause mortality in men with prostate cancer - Abstract

PURPOSE: Accurate estimation of life expectancy is critical for men considering aggressive vs. non-aggressive treatment of early-stage prostate cancer.

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.

Written by:
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.
doi: 10.1016/j.juro.2015.01.081

PubMed Abstract
PMID: 25623745 Prostate Cancer Section