An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer.
PURPOSE
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.


MATERIALS AND 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.
['Daskivich|Timothy J|TJ|', 'Kwan|Lorna|L|', 'Dash|Atreya|A|', 'Saigal|Christopher|C|', 'Litwin|Mark S|MS|']
D000367:Age Factors D000368:Aged D002423:Cause of Death D015897:Comorbidity D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D011471:Prostatic Neoplasms D013997:Time Factors
comorbidity mortality nomograms outcome assessment (health care) prostatic neoplasms