The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy
Ghanem AI, Khalil RM, Khedr GAE, Tang A, Elsaid AA, Chetty I, Movsas B, and Elshaikh MA. The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy. Journal of Clinical Oncology 2019; 37(7 Suppl):114.
J Clin Oncol
Background: Life expectancy is very essential in deciding treatment options in men with prostate cancer (PCa); however, the impact of comorbidities on outcomes is not well-established. We investigated the influence of Charlson Comorbidity Index (CCI) on survival endpoints in men with localized PCa who were treated with prostate radiotherapy (RT). Methods: Men with intermediate and high risk PCa who were treated with definitive RT between 1/2007 and 12/2012 were included. Groups were created according to their baseline CCI score at diagnosis into no, mild and severe comorbidity (CCI 0, 1 or 2+). The groups were then compared based on patients' characteristics and prognostic factors. Kaplan-Meier curves and Uni/multivariate analyses (MVA) were used to examine the impact of CCI groups on overall (OS), disease specific (DSS), and biochemical relapse free (BRFS) survival. Results: 257 patients were identified after excluding low risk, metastatic cases and those with inadequate follow up. Median follow-up was 92 months (range: 21-35) and median age was 73 years (range: 4885). 53% of the cases were black and 67% were of intermediate risk. Median RT dose was 76 Gy and 47% received androgen deprivation therapy. CCI groups 0, 1 and 2+ encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively. Groups were generally wellbalanced. 10 and 15 years OS was significantly different across CCI groups (76% & 53%, 46% & 31% and 55% & 14%, for CCI-0, 1 and 2+ respectively; p < 0.001). CCI-0 had better DSS than CCI2+ (p = 0.03) with no difference for CCI-0 vs 1 (p = 0.1). BRFS was nondifferent among CCI groups (p = 0.99). On MVA, increased CCI was deterministic for OS (p < 0.001) after adjusting for age, Gleason's score and T-stage. For DSS, only age and T3 vs T1/2 were independently prognostic (p < 0.001); whereas CCI1 vs 0 was only marginal (p = 0.05). Conclusions: Higher CCI was a significant predictor of shorter OS in intermediate and high-risk PCa. Baseline comorbiditiesshould be taken into consideration during patient counselling for treatment options and in designing prospective trials for men with localized prostate cancer.