title: Impact of Charlson comorbidity index varies by age in patients with prostate cancer treated by radical prostatectomy: a competing risk regression analysis.
abstract: OBJECTIVE
  To investigate the prognostic impact of the Charlson comorbidity index (CCI) on either cancer-specific mortality (CSM) or other-cause mortality (OCM) according to age in patients with prostate cancer (PC) who underwent radical prostatectomy (RP).
  
  
  METHODS
  Data from 336 patients who underwent RP for PC between 1992 and 2005 were analyzed. Variables, including the preoperative prostate-specific antigen (PSA), prostate volume, clinical stage, and pathologic stage, were compared across age groups (<65 or ≥65 years old). Preexisting comorbidities were evaluated by the CCI, and patients were classified into two CCI score categories (0 or ≥1).
  
  
  RESULTS
  The median (interquartile range) follow-up period was 96 (85-121) months. Subjects were divided into two subgroups according to age: <65 years (n = 151) or ≥65 years (n = 185). There was no significant difference in PSA, biopsy Gleason sum, body mass index, pathologic stage, or CCI between the two age groups. OCM was significantly associated with the CCI score (P = 0.011). Cumulative incidence estimates obtained from competing risk regression analysis indicated that CCI was not associated with CSM (P = 0.795) or OCM (P = 0.123) in the ≥65-year group. However, in men <65 years, cumulative incidence estimates for OCM were significantly associated with CCI (P = 0.036).
  
  
  CONCLUSIONS
  CCI was independently associated with OCM after RP, but only in men <65 years old. CCI was not associated with CSM in either age group. Accordingly, a thorough evaluation of patient's comorbidities is mandatory when considering aggressive surgical treatment, especially in relatively young patients.
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
authors.forename: Dae Hun
authors.initials: DH
authors.lastname: Lee
authors.forename: Nam Hoon
authors.initials: NH
authors.lastname: Cho
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Seung Choul
authors.initials: SC
authors.lastname: Yang
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D012044:Regression Analysis; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen