title: Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer.
abstract: OBJECTIVE
  To evaluate the impact of the Charlson comorbidity index on long-term survival in nonsmall cell lung cancer surgery and determine whether this index is a better predictor of long-term survival than individual comorbid conditions.
  
  
  METHODS
  From January 1989 to December 2001, 433 (340 men, 93 women) consecutive curative resections for nonsmall cell lung cancer were performed. Each patient was preoperatively assessed according to the Charlson comorbidity index. Survival curves were estimated by the Kaplan-Meier method. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis.
  
  
  RESULTS
  The patients ranged in age from 37 to 82 years, with a mean age of 65 years. Hospital mortality was 3.7%. Five-year overall and disease free survival was 45 and 43%, respectively. Among patients with Charlson comorbidity grade 0, 5-year overall survival was 52%, among patients with Charlson comorbidity grade 1-2 it was 48%, and among patients with Charlson comorbidity grade > or =3 it was 28%. Univariate analysis showed that male gender, age, congestive heart failure, chronic pulmonary disease, Charlson comorbidity index, clinical stage, pathological stage, and type of resection were significantly associated with an impaired survival. Multivariate analysis showed that age (relative risk, 1.02; 95% confidence interval, 1.01-1.03), Charlson comorbidity grade 1-2 (relative risk, 1.4; 95% confidence interval, 1.0-1.8), Charlson comorbidity grade > or =3 (relative risk, 2.2; 95% confidence interval, 1.5-3.1), bilobectomy (relative risk, 1.7; 95% confidence interval, 1.2-2.5), pneumonectomy (relative risk, 1.5; 95% confidence interval, 1.1-2.0), pathological stage IB (relative risk, 1.5; 95% confidence interval, 1.1-2.2), IIB (relative risk, 1.9; 95% confidence interval, 1.2-3.0), IIIA (relative risk, 1.9; 95% confidence interval, 1.1-3.1), IIIB (relative risk, 2.8; 95% confidence interval, 1.2-6.8), and IV (relative risk, 12.4; 95% confidence interval, 3.2-48.2), were associated with an impaired survival.
  
  
  CONCLUSIONS
  The Charlson comorbidity index is a better predictor of survival than individual comorbid conditions in nonsmall cell lung cancer surgery. We recommend the use of a validated comorbidity index in the selection of patients for NSCLC surgery.
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Birim
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome