title: Age-adjusted Charlson comorbidity index is a significant prognostic factor for long-term survival of patients with high-risk prostate cancer after radical prostatectomy: a Bayesian model averaging approach.
abstract: OBJECTIVE
  We investigated the long-term prognostic impact of age-adjusted Charlson comorbidity index (ACCI) on overall mortality (OM), cancer-specific mortality (CSM), and other-cause mortality (OCM) according to risk stratification in patients with prostate cancer who underwent radical prostatectomy.
  
  
  METHODS
  Data from 542 patients who underwent radical prostatectomy between 1992 and 2006 were analyzed. The impact of preoperative variables including age, prostate-specific antigen, biopsy Gleason sum, clinical stage, and ACCI on OM, CSM, and OCM were analyzed according to risk groups, with a median follow-up of 101 months.
  
  
  RESULTS
  Subjects were stratified into either the high-risk group (n = 241) or the non-high-risk group (n = 301). Cox proportional hazards model demonstrated that the ACCI was the only significant predictor for OM in all patients (hazard ratio, HR 1.41; 95 % confidence interval, CI 1.19-1.66), non-high-risk group (HR 1.45; 95 % CI 1.09-1.91), and high-risk group (HR 1.37; 95 % CI 1.11-1.69). In competing risk analysis, CSM was not associated with the ACCI in either risk group. However, the ACCI had a significant impact on OCM in both the non-high-risk (HR 1.55; 95 % CI 1.16-2.1) and high-risk groups (HR 1.60; 95 % CI 1.23-2.08). A Bayesian model averaging approach verified that the ACCI was the most powerful predictor for OM and OCM in the both high-risk and non-high-risk groups.
  
  
  CONCLUSIONS
  A thorough assessment of comorbidities is mandatory in establishing prognoses, even when considering invasive treatment modalities in high-risk prostate cancer 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.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Ho Won
authors.initials: HW
authors.lastname: Kang
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Nam Hoon
authors.initials: NH
authors.lastname: Cho
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea. kscho99@yuhs.ac.
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
mesh_terms: D000367:Age Factors; D000368:Aged; D001499:Bayes Theorem; D014408:Biomarkers, Tumor / Q000097:blood*; D015897:Comorbidity; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Bayes theorem; Comorbidity; Mortality; Prostatic neoplasms; Risk