title: Short-Form Charlson Comorbidity Index for Assessment of Perioperative Mortality After Radical Cystectomy.
abstract: Background:The Deyo adaptation of the Charlson comorbidity index (DaCCI), which relies on 17 comorbid condition groupings, represents one of the most frequently used baseline comorbidity assessment tools in retrospective database studies. However, this index is not specific for patients with bladder cancer (BCa) treated with radical cystectomy (RC). The goal of this study was to develop a short-form of the original DaCCI (DaCCI-SF) that may specifically predict 90-day mortality after RC, with equal or better accuracy.Patients and Methods:Between 2000 and 2009, we identified 7,076 patients in the SEER-Medicare database with stage T1 through T4 nonmetastatic BCa treated with RC. We randomly divided the population into development (n=6,076) and validation (n=1,000) cohorts. Within the development cohort, logistic regression models tested the ability to predict 90-day mortality with various iterations of the DaCCI-SF, wherein <17 original comorbid condition groupings were included after adjusting for age, sex, race, T stage, and N stage. We relied on the Akaike information criterion to identify the most parsimonious and informative set of comorbid condition groupings. Accuracy of the DaCCI and the DaCCI-SF was tested in the external validation cohort.Results:Within the development cohort, the most parsimonious and informative model resulted in the inclusion of 3 of the 17 (17.6%) original comorbid condition groupings: congestive heart failure, cerebrovascular disease, and chronic pulmonary disease. Within the validation cohort, the accuracy was 68.4% for the DaCCI versus 69.7% for the DaCCI-SF. Higher accuracy of the DaCCI-SF was confirmed in subgroup analyses performed according to age (≤75 vs >75 years), stage (organ-confined vs non-organ-confined), type of diversion (ileal-conduit vs non-ileal-conduit), and treatment period.Conclusions:DaCCI-SF relies on 17.6% of the original comorbid condition groupings and provides higher accuracy for predicting 90-day mortality after RC compared with the original DaCCI, especially in most contemporary patients.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada|Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada|Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada|Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
authors.forename: Sami-Ramzi
authors.initials: SR
authors.lastname: Leyh-Bannurah
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada|Department of Urology, University of Montreal Health Center, Montreal, Canada
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Ettore
authors.initials: E
authors.lastname: Di Trapani
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy|Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, Canada
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada|Department of Urology, University of Montreal Health Center, Montreal, Canada
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011159:Population Surveillance; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery