title: Age-adjusted Charlson comorbidity index scores as predictor of survival in colorectal cancer patients who underwent surgical resection and chemoradiation.
abstract: We studied the effect of Age-Adjusted Comorbidity Index Score in colorectal cancer patients who underwent similarly aggressive treatment. Using the National Health Insurance Research Database of Taiwan, we identified 5643 patients with colorectal cancer who underwent surgical resection and chemoradiation from 2007 through 2011. We estimated survival according to Age-Adjusted Comorbidity Index Scores and 5-year survival using Cox proportional hazard regression analysis, adjusting for sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital characteristics. In the cohort were 3230 patients with colonic cancer and 2413 patients with rectal cancer, who had undergone combined surgical resection and either neoadjuvant or adjuvant chemoradiation. After adjusting for patient characteristics (sex, oxaliplatin-based chemotherapy, socioeconomic status, geographic region, and hospital-characteristics), colonic cancer patients with age-adjusted Charlson (AAC) ≥ 6 had a 106% greater risk of death within 5 years (adjusted HR = 2.06; 95% CI, 1.66-2.56). In rectal cancer patients, patients with an AAC score of 4-5 had a 28% greater risk of death within 5 years (adjusted HR = 1.28; 95% CI, 1.02-1.61), and those with AAC ≥ 6 had a 47% greater risk (adjusted HR = 1.47; 95% CI, 1.15-1.90). Age and burden of comorbidities influence survival of patients with colonic or rectal cancer. Age-Adjusted Comorbidity Score remains an independent prognostic factor even after adjusting for the aggressiveness of treatment.
authors.affiliation: From the Division of Colorectal Surgery (C-CW, T-WH); Division of General Surgery, Department of Surgery (C-MC); Department of Otolaryngology (C-CL); Center for Clinical Epidemiology and Biostatistics (C-HY, C-CL); Department of Education (C-CL); Department of Research (C-HY) Cancer Center (C-CW, T-WH, C-MC, C-CL), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; School of Medicine (T-WH, C-M C, C-CL), Tzu Chi University, Hualien; and Community Medicine Research Center and Institute of Public Health (C-CL), National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chin-Chia
authors.initials: CC
authors.lastname: Wu
authors.forename: Ta-Wen
authors.initials: TW
authors.lastname: Hsu
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Yu
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin