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A drug comorbidity index to predict mortality in men with castration resistant prostate cancer

Giuseppe Fallara1,2,3, Rolf Gedeborg3, Anna Bill-Axelson3

  • 1Division of Experimental Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Milan, Italy.

Plos One
|July 28, 2021
PubMed

Insights

A new drug comorbidity index (DCI-CRPC) using prescription data predicts mortality in castration resistant prostate cancer (CRPC) patients better than the Charlson Comorbidity Index, improving prognostic accuracy.

Area of Science:

  • Oncology
  • Epidemiology
  • Pharmacology

Background:

  • The Charlson Comorbidity Index (CCI) has limitations in predicting mortality for men with castration resistant prostate cancer (CRPC).
  • A novel comorbidity index, the drug comorbidity index (DCI-CRPC), was developed using filled prescription data for improved prognostic accuracy in CRPC patients.
  • This index is designed for use in registry-based studies.

Purpose of the Study:

  • To develop and validate a new comorbidity index (DCI-CRPC) for predicting mortality in men with castration resistant prostate cancer (CRPC).
  • To compare the predictive performance of the DCI-CRPC against the Charlson Comorbidity Index (CCI) and an original DCI in a population-based cohort.

Main Methods:

  • A population-based cohort of 1,885 men with CRPC was analyzed.
  • The drug comorbidity index (DCI-CRPC) was calculated based on prescriptions filled within 365 days prior to CRPC diagnosis.
  • Mortality prediction was assessed using Kaplan-Meier curves and compared with CCI and original DCI via univariable models and C-indices.

Main Results:

  • The DCI-CRPC demonstrated superior discriminative ability (C-index 0.667) compared to the Charlson Comorbidity Index (C-index 0.508).
  • Median overall survival varied significantly across DCI-CRPC tertiles, from 3.0 years to 1.0 year.
  • The DCI-CRPC showed comparable performance to the original DCI and its discriminative ability was highest in less aggressive cancer subgroups.

Conclusions:

  • The newly developed drug comorbidity index (DCI-CRPC) effectively predicts mortality in men with castration resistant prostate cancer (CRPC).
  • The DCI-CRPC offers improved prognostic accuracy over the Charlson Comorbidity Index for CRPC patients.
  • This prescription-based index is a valuable tool for registry-based studies in oncology.
Abstract

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