Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Eur Urol. 2014 Dec;66(6):1002-9. doi: 10.1016/j.eururo.2014.05.029. Epub 2014 Jun 9.
Clinicians need a simple yet accurate method to predict other-cause mortality to inform medical decision making for men with prostate cancer (PCa).
To compare weighted and unweighted Charlson Comorbidity Index scores in predicting long-term, other-cause mortality in men with early-stage PCa.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 1482 men with early-stage PCa diagnosed in 1998-2004 at two Southern California Veterans Affairs medical centers.
Subhazard ratios and cumulative incidence of other-cause mortality associated with weighted and unweighted Charlson scores, calculated by competing-risks regression accounting for cancer mortality, along with Harrell concordance index (C-index) values.
Weighted and unweighted Charlson scores were identical in 88.6% of subjects (1313 of 1482 men) across all scores and in 91.7% of subjects (1359 of 1482 men) across scores of 0, 1, 2, and ≥3. In competing-risks analysis, hazards of other-cause mortality were similar when comparing weighted and unweighted scores. Men with weighted scores of 1, 2, and ≥3 (vs. 0) had subhazard ratios of 2.3 (95% confidence interval [CI], 1.6-3.2), 4.1 (95% CI, 2.9-5.8), and 8.3 (95% CI, 5.9-11.5), respectively. Men with unweighted scores of 1, 2, and ≥3 (vs. 0) had subhazard ratios of 2.5 (95% CI, 1.8-3.5), 4.5 (95% CI, 3.2-6.3), and 10.3 (95% CI, 7.2-14.7), respectively. The C-indexes for prediction of other-cause mortality were nearly identical for weighted scores (0.759 [95% CI, 0.715-0.780]) and unweighted scores (0.756 [95% CI, 0.717-0.780]). The difference in C-index between the two methods was -0.003 (95% CI, -0.01 to 0.004).
An unweighted Charlson score yields similar strength of association and variance in predicting long-term, other-cause mortality compared with a weighted Charlson score.
A simple count of major comorbidities provides similar accuracy to a weighted index in predicting death from other causes in men with early-stage prostate cancer.
临床医生需要一种简单而准确的方法来预测其他原因导致的死亡率，以便为患有前列腺癌 (PCa) 的男性提供医学决策依据。
比较加权和非加权 Charlson 合并症指数评分在预测早期 PCa 男性长期其他原因死亡率方面的作用。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 1998-2004 年在加利福尼亚州南部的两家退伍军人事务医疗中心诊断为早期 PCa 的 1482 名男性。
使用竞争风险回归分析，考虑癌症死亡率，计算加权和非加权 Charlson 评分与其他原因死亡率相关的亚风险比和累积发生率，同时计算 Harrell 一致性指数 (C-index) 值。
在所有评分中，88.6%（1482 名男性中的 1313 名）和在评分 0、1、2 和≥3 中 91.7%（1482 名男性中的 1359 名）的患者中，加权和非加权 Charlson 评分完全相同。在竞争风险分析中，比较加权和非加权评分时，其他原因导致的死亡风险相似。加权评分 1、2 和≥3（与 0 相比）的患者亚风险比分别为 2.3（95%置信区间 [CI]，1.6-3.2）、4.1（95% CI，2.9-5.8）和 8.3（95% CI，5.9-11.5）。非加权评分 1、2 和≥3（与 0 相比）的患者亚风险比分别为 2.5（95% CI，1.8-3.5）、4.5（95% CI，3.2-6.3）和 10.3（95% CI，7.2-14.7）。加权评分（0.759 [95% CI，0.715-0.780]）和非加权评分（0.756 [95% CI，0.717-0.780]）预测其他原因死亡率的 C-index 几乎相同。两种方法的 C-index 差值为 -0.003（95% CI，-0.01 至 0.004）。
与加权 Charlson 评分相比，非加权 Charlson 评分在预测早期前列腺癌男性长期其他原因死亡率方面具有相似的关联强度和变异性。
在预测早期前列腺癌男性因其他原因导致的死亡方面，主要合并症的简单计数与加权指数具有相似的准确性。
