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Association between Charlson comorbidity index and survival outcomes in patients with prostate cancer: A
Feilun Cui1, Yue Qiu2, Wei Xu2
1Department of Urology, Affiliated Taizhou Second People's Hospital of Yangzhou University, Taizhou, 225500, China.
Insights
Comorbidity, measured by the Charlson Comorbidity Index (CCI), significantly increases all-cause and other-cause mortality in prostate cancer (PCa) patients. However, CCI does not impact prostate cancer-specific mortality.
Area of Science:
- Oncology
- Epidemiology
- Biostatistics
Background:
- Comorbidity is a significant factor influencing patient outcomes in various diseases.
- The Charlson Comorbidity Index (CCI) is a widely used tool to quantify comorbidity burden.
- Understanding the impact of comorbidity on prostate cancer (PCa) survival is crucial for patient management.
Purpose of the Study:
- To evaluate the association between comorbidity, assessed using the Charlson Comorbidity Index (CCI), and survival outcomes in prostate cancer (PCa) patients.
- To determine if the CCI score influences all-cause mortality, PCa-specific mortality, and other-cause mortality.
Main Methods:
- A systematic meta-analysis was conducted using data from PubMed, Web of Science, and Embase.
- Included studies focused on the relationship between CCI-defined comorbidity and survival in PCa patients.
- A random effects model was utilized to pool adjusted hazard ratios (HR) and 95% confidence intervals (CI).
Main Results:
- The meta-analysis included 16 studies with 457,256 patients.
- Comorbidity (CCI ≥1) was associated with increased all-cause mortality (HR 1.59) and other-cause mortality (HR 1.88).
- The risk of all-cause and other-cause mortality escalated with higher CCI scores, while PCa-specific mortality was not significantly affected (HR 0.98).
Conclusions:
- Increased comorbidity burden, as measured by the CCI, is a significant predictor of all-cause and other-cause mortality in PCa patients.
- The CCI score is a valuable tool for risk stratification in PCa, particularly for predicting non-cancer-related deaths.
- Further research may explore interventions to mitigate the impact of comorbidity on PCa survival.
Objective:
This meta-analysis aimed to assess the influence of comorbidity, as assessed by the Charlson comorbidity index (CCI), on survival outcomes in patients with prostate cancer (PCa).
Methods:
We conducted a comprehensive search of the PubMed, Web of Science, and Embase databases to identify studies that examined the association between CCI-defined comorbidity and survival outcomes in PCa patients. We employed a random effect model to merge adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for survival outcomes.
Results:
Sixteen studies reporting on 17 articles, which collectively included 457,256 patients. For the presence (CCI score ≥1) versus absence (CCI score of 0) of comorbidity, the pooled HR was 1.59 (95 % CI 1.43-1.77) for all-cause mortality, 0.98 (95 % CI 0.90-1.08) for PCa-specific mortality, and 1.88 (95 % CI 1.61-2.21) for other-cause mortality. When compared to a CCI score of 0, the pooled HR of all-cause mortality was 1.30 (95 % CI 1.18-1.44) for a CCI score of 1, 1.65 (95 % CI 1.37-2.00) for a CCI score ≥2, and 1.75 (95 % CI 1.57-1.95) for a CCI score ≥3. Additionally, the pooled HR of other cause mortality was 1.53 (95 % CI 1.41-1.67) for a CCI score of 1, 1.93 (95 % CI 1.74-2.75) for a CCI score ≥2, and 3.95 (95 % CI 2.13-7.34) for a CCI score ≥3.
Conclusions:
Increased comorbidity, as assessed by the CCI, significantly predicts all-cause and other-cause mortality in patients with PCa, but not PCa-specific mortality. The risk of all-cause and other-cause mortality increases with the burden of comorbidity.
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