title: Association of the Charlson comorbidity index and hypertension with survival in men with metastatic castration-resistant prostate cancer.
abstract: OBJECTIVE
  The independent prognostic effect of comorbidities on outcomes in men with metastatic castration-resistant prostate cancer (mCRPC) is unclear. We sought to determine whether the Charlson comorbidity index (CCI) and hypertension (HTN) are associated with overall survival (OS) independent of known clinical prognostic factors in mCRPC.
  
  
  METHODS
  A retrospective analysis was conducted on 221 patients with mCRPC treated with docetaxel plus prednisone combined with AT-101 (bcl-2 antagonist) or placebo on a prospective randomized phase II trial. The Cox regression analysis was performed to identify whether the CCI or HTN or both (by medical history) independently predicted OS after adjusting for baseline variables known to be associated with OS. The Wilcoxon rank sum test and the Fisher exact test were used to compare data by comorbidity groups (CCI as a continuous variable, CCI = 6 vs. CCI ≥ 7 and HTN vs. no HTN).
  
  
  RESULTS
  The CCI was 6 in 116 patients (52.7%), 7 in 70 (31.8%), 8 in 23 (10.5%), 9 in 4 (1.8%), and 10 in 7 patients (3.2%). HTN was present in 107 (48.6%) patients. Patients with CCI of ≥ 7 were older and exhibited worse performance status and anemia than patients with CCI of 6 (P<0.05). The CCI was not independently predictive of OS on univariable and multivariable analyses. HTN alone or in combination with the CCI was borderline significantly associated with OS (P ~ 0.09) on both univariable and multivariable analyses.
  
  
  CONCLUSIONS
  The CCI did not predict OS independent of known prognostic factors in mCRPC. Age, performance status, and anemia may adequately capture comorbidities in the context of mCRPC, given their association with higher CCI. Further prospective study of comorbidities in a larger data set may be warranted. The study of HTN in a larger data set may also be warranted given its borderline-independent association with OS.
authors.affiliation: Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Goyal
authors.affiliation: Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, The Mount Sinai School of Medicine, New York, NY.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, The Mount Sinai School of Medicine, New York, NY.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hendricks
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, The Mount Sinai School of Medicine, New York, NY.
authors.forename: Alexander
authors.initials: A
authors.lastname: Small
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, The Mount Sinai School of Medicine, New York, NY.
authors.forename: Che-Kai
authors.initials: CK
authors.lastname: Tsao
authors.affiliation: Department of Medicine, Section of Hematology and Oncology, The University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL. Electronic address: gsonpavde@uabmc.edu.
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000368:Aged; D000465:Algorithms; D015897:Comorbidity; D018572:Disease-Free Survival; D000077143:Docetaxel; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D064129:Prostatic Neoplasms, Castration-Resistant / Q000150:complications* / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel
keywords: Charlson comorbidity index; Docetaxel; Hypertension; Metastatic castration-resistant prostate cancer; Overall survival; Progression-free survival