title: Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients.
abstract: BACKGROUND
  Cancer survival is related not only to primary malignancy but also to concomitant nonmalignant diseases. The aim of this study was to investigate the prognostic capacity of four comorbidity indices [the Charlson comorbidity index (CCI), the Elixhauser method, the National Institute on Aging (NIA) and National Cancer Institute (NCI) comorbidity index, and the Adult Comorbidity Evaluation-27 (ACE-27)] for both cancer-related and all-cause mortality among colorectal cancer patients. A modified version of the CCI adapted for colorectal cancer patients was also built.
  
  
  METHODS
  The study population comprised 468 cases of colorectal cancer diagnosed between 1 January 2000 and 31 December 2010 at a community hospital. Data were prospectively collected and abstracted from patients' clinical records. Kaplan-Meier method and multivariate logistic regression models were performed for survival and risk of death analysis.
  
  
  RESULTS
  Only moderate or severe renal disease [hazard ratio (HR) 2.71, 95% confidence interval (CI) 1.11-6.63] and AIDS (HR 3.27, 95% CI 1.23-8.68) were independently associated with cancer-specific mortality, with a population attributable risk of 5.18 and 4.36%, respectively. For each index, the highest comorbidity burden was significantly associated with poorer overall survival (NIA/NCI: HR 2.14, 95% CI 1.14-4.01; Elixhauser: HR 1.98, 95% CI 1.09-1.42; ACE-27: HR 1.78, 95% CI 1.07-1.23; CCI: HR 1.68, 95% CI 1.05-1.42) and cancer-specific survival. The modified version of the CCI resulted in a higher predictive power compared with other indices studied (cancer-specific mortality HR = 2.37, 95% CI 1.37-4.08).
  
  
  CONCLUSIONS
  The comorbidity assessment tools provided better prognostic prevision of prospective outcome of colorectal cancer patients than single comorbid conditions.
authors: Department "G. F. Ingrassia," Section of Hygiene and Public Health, University of Catania, Catania, Italy.
authors: Stefano
authors: S
authors: Marventano
authors: Giuseppe
authors: G
authors: Grosso
authors: Antonio
authors: A
authors: Mistretta
authors: Marta
authors: M
authors: Bogusz-Czerniewicz
authors: Roberta
authors: R
authors: Ferranti
authors: Francesca
authors: F
authors: Nolfo
authors: Gabriele
authors: G
authors: Giorgianni
authors: Stefania
authors: S
authors: Rametta
authors: Filippo
authors: F
authors: Drago
authors: Francesco
authors: F
authors: Basile
authors: Antonio
authors: A
authors: Biondi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality*; D015897:Comorbidity; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods