Using the California Cancer Registry (CRR), the study identified 1,915 men who were newly diagnosed with prostate cancer at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1998-2004. The exclusion criteria were: men with no prostate cancer diagnosis, histology other than adenocarcinoma, incidental diagnosis at cystoprostatectomy, metastatic disease, and those with insufficient data to determine comorbidities or treatment. In total, 1,462 cases satisfied the inclusion criteria. To identify men in the lowest quartile, the researchers used Charlson Comorbidity scores, calculated their NCCN-predicated life expectancy, and compared with observed median survival in aggregate and across comorbidity subgroups. An alpha level of 0.05 was used to denote statistical significance for statistical analysis.
The results of the study showed that men with Charlson scores of 2+ (age <75) and 3+ (age ≥75) comprised of the lowest quartile of health. Among those <65, 65-69, 70-74, 75-79, and ≥80 years, observed survival vs NCCN-predicted life expectancy in years was similar: 10.4 vs. 16 11.1, 10.0 vs. 7.8, 6.2 vs. 6.4, 4.4 vs. 4.9, and 3.7 vs. 3.3, respectively. Although on average survival of those in lowest quartile of health was similar to NCCN-predicted survival, there was significant heterogeneity in survival among men differing Charlson scores. This demonstrates that NCCN guidelines misclassified 10-year life expectancy in 24% and 56% of men aged <65 and 65-69, and 5-year life expectancy in 18% of men age 70-74.
The heterogeneity in survival among those with different Charlson scores led to over- and underestimation of survival by the NCCN Method. In conclusion, the findings in this study argue that a more accurate determination of life expectancy assessment needed when deciding treatment for men with prostate cancer, one that integrate both Charlson comorbidities with the NCCN method.
Authors: Timothy J. Daskivich, MD, MSHPM, Laudren, MD, Douglas Skarecky, AB, Thomas Ahlering, MD, Stephen Freedland, MD
Affiliations: 1Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 2Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Los Angeles, CA 3Department of Urology, University of California, Irvine, Irvine, California 4Long Beach Veterans Affairs Medical Center, Long Beach, California 5Durham Veterans Affairs Medical Center, Durham, North Carolina
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