Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1738, USA.
J Urol. 2011 Nov;186(5):1868-73. doi: 10.1016/j.juro.2011.07.033. Epub 2011 Sep 23.
Comorbidity assessment is essential to triage of care for men with prostate cancer. We identified long-term risks of other cause mortality associated with comorbidities in the Charlson index and applied these to the creation of a prostate cancer specific comorbidity index.
We sampled 1,598 cases of prostate cancer diagnosed in 1997 to 2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers. We used Cox proportional hazards modeling to determine the risks of other cause mortality associated with comorbidities and used these hazard ratios to re-weight the Charlson index. We then compared the ability of each index to predict other cause mortality.
Cox modeling showed that moderate to severe liver disease, metastatic solid tumor, lymphoma and leukemia carried the highest risk (HR greater than 5) for other cause mortality, followed by moderate to severe chronic obstructive pulmonary disease, moderate to severe renal disease, dementia, hemiplegia and congestive heart failure (HR 2.5 to less than 3.5). The revised and original Charlson indices performed similarly in predicting other cause mortality across all patients (c-index 0.816 vs 0.802). However, in survival analysis our revised index identified 137 men with a greater than 90% probability of other cause mortality within 10 years while the original Charlson identified only 51. In multivariate modeling the odds of 5-year other cause mortality for men with original Charlson scores 1, 2, 3 and 4+ were 2.9, 6.0, 9.2 and 29.8, respectively, compared with 3.9, 6.2, 12.8 and 84.2 for the revised index.
Re-weighting the Charlson index allowed for more accurate identification of men at highest risk for other cause mortality. Our revised index may be used to aid medical decision making for men with prostate cancer.
合并症评估对于前列腺癌患者的护理分诊至关重要。我们确定了 Charlson 指数中合并症相关的其他原因死亡率的长期风险，并将这些风险应用于创建前列腺癌特异性合并症指数。
我们在 1997 年至 2004 年期间从大洛杉矶和长滩退伍军人事务医疗中心诊断出的 1598 例前列腺癌病例中进行了抽样。我们使用 Cox 比例风险模型来确定与合并症相关的其他原因死亡率的风险，并使用这些风险比重新加权 Charlson 指数。然后，我们比较了每个指数预测其他原因死亡率的能力。
Cox 模型显示，中度至重度肝病、转移性实体瘤、淋巴瘤和白血病对其他原因死亡率的风险最高（HR 大于 5），其次是中度至重度慢性阻塞性肺疾病、中度至重度肾功能不全、痴呆、偏瘫和充血性心力衰竭（HR 2.5 至小于 3.5）。修订后的和原始的 Charlson 指数在预测所有患者的其他原因死亡率方面表现相似（c 指数为 0.816 与 0.802）。然而，在生存分析中，我们的修订指数确定了 137 名男性在 10 年内其他原因死亡率超过 90%的可能性，而原始 Charlson 仅确定了 51 名。在多变量建模中，原始 Charlson 评分为 1、2、3 和 4+的男性在 5 年内发生其他原因死亡的几率分别为 2.9、6.0、9.2 和 29.8，而修订后的指数分别为 3.9、6.2、12.8 和 84.2。
重新加权 Charlson 指数可以更准确地识别其他原因死亡率最高的男性。我们的修订指数可用于帮助前列腺癌患者做出医疗决策。
