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Chen MS, Howard LE, Stock S, Dolgner A, Freedland SJ, Aronson W, Terris M, Klaassen Z, Kane C, Amling C, Cooperberg M, Daskivich TJ. Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy. Prostate Cancer Prostatic Dis 2023; 26:715-721. [PMID: 35668181 DOI: 10.1038/s41391-022-00550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/17/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). MATERIALS AND METHODS We sampled 4857 men with prostate cancer treated with RP in the VA from 2000-2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality. RESULTS Over median follow-up of 6.7 years (IQR 3.7-10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26-9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations. CONCLUSIONS The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.
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Affiliation(s)
- Michelle S Chen
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Lauren E Howard
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Urology, Duke University, Durham, NC, USA
| | - Shannon Stock
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
| | | | - Stephen J Freedland
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William Aronson
- Division of Urology, West Los Angeles VA Medical Center, Los Angeles, CA, USA
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA
| | - Martha Terris
- Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
- Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Zachary Klaassen
- Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
- Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Christopher Kane
- Department of Urology, University of California, San Diego, CA, USA
| | - Christopher Amling
- Department of Urology, Oregon Health Sciences University, Portland, OR, USA
| | - Matthew Cooperberg
- Department of Urology, University of California, San Francisco, CA, USA
- Section of Urology, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Timothy J Daskivich
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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