Which comorbidity classification best fits elderly candidates for radical prostatectomy?

OBJECTIVES

Comorbidity assessment may assist in the treatment choice for elderly men with prostate cancer. There is, however, no consensus on the best comorbidity classification for this purpose. In this study, we used a heuristic approach to identify an optimal comorbidity classification in elderly men selected for radical prostatectomy.

METHODS AND MATERIALS

A total of 1,106 men aged 65 years or older who underwent radical prostatectomy for clinically localized prostate cancer were stratified by 11 3-sided comorbidity classifications. Overall survival was the study endpoint. The comorbidity classifications were evaluated considering 4 statistical (height of hazard ratios and P values, survival difference between high and low risk patients, dose-response relationship) and 4 clinical demands (survival rates in low and high risk group, balance of the proportion of the risk groups). The 3 best classifications in each category received 3, 2, or 1 point. After adding all points, the classification with the highest score was considered best.

RESULTS

With one exception, all comorbidity classifications were significant predictors of overall survival. Comparing the highest with the lowest risk group, the hazard ratios ranged between 1.67 and 3.93. Concerning the fulfillment of clinical and statistical demands, the American Society of Anesthesiologists (ASA) physical status classification and 1 derivative of it that included further more clearly defined diseases were the most promising candidates.

CONCLUSIONS

Stratifying candidates for radical prostatectomy according to their mortality risk using the ASA classification as a backbone supplemented by a list of more clearly defined concomitant diseases could be useful in clinical practice and outcome studies.