Alibhai Shabbir M H, Leach Marc, Tomlinson George A, Krahn Murray D, Fleshner Neil E, Naglie Gary
Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Ontario, Canada.
Cancer. 2008 Mar 1;112(5):1043-50. doi: 10.1002/cncr.23269.
Comorbidity is an important consideration in oncology practice, particularly among older patients. Although a variety of comorbidity indices have been employed in research studies, it is unclear whether any one index is preferred.
An age-stratified random sample of 345 men (mean age of 69 years) who were newly diagnosed with prostate cancer were identified from a cancer registry in Ontario, Canada. Comorbidity and treatment information were obtained from chart review. Four comorbidity indices were utilized: Charlson Index, Diagnosis Count, Index of Coexistent Disease (ICED), and number of medications. Logistic regression analysis was used to compare the performance of comorbidity measures with respect to predicting receipt of curative treatment (radical prostatectomy or radiotherapy) and overall 6-year survival. Multivariable model performance including each of the comorbidity measures was compared by calculating the area under the receiver operating characteristic curve (AUROC).
Among men with localized disease (n = 231), in models adjusted for age, Gleason score, and prostate-specific antigen level, only the Charlson Index was found to be a statistically significant predictor of receipt of curative treatment (P < .05), although all comorbidity indices had similar AUROC in adjusted models. After a median follow-up of 6.5 years, 116 of 345 men (33.6%) had died. In adjusted models, all 4 comorbidity indices performed similarly in predicting overall survival.
Although comorbidity is an important predictor of both curative treatment and overall survival in prostate cancer, the optimal comorbidity index for use in research remains unclear. Selecting the optimal comorbidity index may depend on both the specific patient population and the outcome being considered.
合并症是肿瘤学实践中的一个重要考量因素，在老年患者中尤为如此。尽管在研究中使用了多种合并症指数，但尚不清楚是否有某一种指数更受青睐。
从加拿大安大略省的癌症登记处中确定了345名新诊断为前列腺癌的男性（平均年龄69岁）的年龄分层随机样本。通过病历审查获取合并症和治疗信息。使用了四种合并症指数：查尔森指数、诊断计数、共存疾病指数（ICED）和用药数量。采用逻辑回归分析来比较合并症测量指标在预测根治性治疗（根治性前列腺切除术或放疗）的接受情况和6年总生存率方面的表现。通过计算受试者操作特征曲线下面积（AUROC）来比较包括每种合并症测量指标在内的多变量模型性能。
在局限性疾病患者（n = 231）中，在根据年龄、 Gleason评分和前列腺特异性抗原水平进行调整的模型中，仅查尔森指数被发现是接受根治性治疗的统计学显著预测因素（P <.05），尽管在调整后的模型中所有合并症指数的AUROC相似。在中位随访6.5年后，345名男性中有116名（33.6%）死亡。在调整后的模型中，所有4种合并症指数在预测总生存率方面表现相似。
尽管合并症是前列腺癌根治性治疗和总生存率的重要预测因素，但用于研究的最佳合并症指数仍不明确。选择最佳合并症指数可能既取决于特定的患者群体，也取决于所考虑的结局。
