title: An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer.
abstract: OBJECTIVE
  Accurate estimation of life expectancy is critical for men considering aggressive vs nonaggressive treatment of early stage prostate cancer. We created an age adjusted comorbidity index that predicts other cause mortality in men with prostate cancer.
  
  
  METHODS
  We sampled 1,598 men consecutively diagnosed with prostate cancer between 1998 and 2004 at West Los Angeles and Long Beach Veterans Affairs hospitals. We used competing risks regression in testing and validation cohorts to determine the risk of nonprostate cancer related (ie other cause) mortality associated with age at diagnosis and PCCI score. We converted risk into a 10-point scoring system and calculated 2, 5 and 10-year cumulative incidence of other cause mortality by age adjusted PCCI scores.
  
  
  RESULTS
  PCCI score and age were associated with similar hazards of other cause mortality in the testing and validation cohorts. Each 6-year increase in age at diagnosis of greater than 60 was equivalent to 1 additional PCCI point. After correcting PCCI score for age the age adjusted PCCI scores were strongly predictive of other cause mortality. The subhazard ratio of other cause mortality vs 0 for a score of 0, 1-2, 3-4, 5-6, 7-9 and 10+ was 2.0 (95% CI 1.3-3.0), 4.0 (95% CI 2.6-6.1), 8.7 (95% CI 5.7-13.3), 14.7 (95% CI 9.4-22.8) and 43.2 (95% CI 26.6-70.4), respectively. The 10-year cumulative incidence of other cause mortality was 10%, 19%, 35%, 60%, 79% and 99%, respectively.
  
  
  CONCLUSIONS
  The age adjusted PCCI strongly stratifies the risk of long-term, other cause mortality. It may be incorporated into shared decision making to decrease overtreatment of older and chronically ill men with prostate cancer.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California. Electronic address: tdaskivich@ucla.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
authors.affiliation: Jonsson Comprehensive Cancer Center and Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality*; D013997:Time Factors
keywords: comorbidity; mortality; nomograms; outcome assessment (health care); prostatic neoplasms