Age-adjusted charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer Journal Article

  

Authors:	Koppie, T. M.; Serio, A. M.; Vickers, A. J.; Vora, K.; Dalbagni, G.; Donat, S. M.; Herr, H. W.; Bochner, B. H.
Article Title:	Age-adjusted charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer
Abstract:	BACKGROUND. By using the age-adjusted Charlson comorbidity index (ACCI), the authors characterized the impact of age and comorbidity on disease progression and overall survival after radical cystectomy (RC) for transitional cell carcinoma of the bladder. Also evaluated was whether ACCI was associated with clinicopathologic and treatment characteristics. METHODS. The authors evaluated 1121 patients treated by RC for transitional cell carcinoma of the bladder at a single institution (1990-2004). Logistic regression was used to determine the relation between ACCI and clinical features. They evaluated the association between ACCI and overall and progression-free survival by using multivariate survival-time models with pathologic stage and nodal status as covariates. RESULTS. ACCI scores increased during the study period (P = .009). Extravesical disease was present in 43% of patients with ACCI ≤2, 49% with ACCI 3-5, and 56% with ACCI >5 (P = .051). Despite their higher prevalence of extravesical disease, patients with higher ACCI were less likely to have lymph-node dissection (odds ratio, 0.55 and 0.35, respectively, for ACCI 3-5 and >5 vs ≤2; P = .005), and when it was performed, fewer lymph nodes were evaluated (P < .0005). Patients with higher ACCI were also less likely to have postoperative chemotherapy (odds ratio, 0.70 and 0.66, respectively, for ACCI 3-5 and >5 vs ≤2; P = .04). Higher ACCI was significantly associated with lower overall (P < .005) but not recurrence-free (P = .17) survival after RC. CONCLUSIONS. Age and comorbidity among patients who underwent RC at a cancer referral hospital increased with time. Both age and comorbidity were associated with treatment selection and survival and should, therefore, be considered when comparing outcomes after RC. © 2008 American Cancer Society.
Keywords:	adult; cancer chemotherapy; cancer survival; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; survival rate; major clinical study; overall survival; clinical feature; clinical trial; disease course; mortality; disease free survival; postoperative care; outcome assessment; antineoplastic agent; lymph node dissection; clinical assessment; prevalence; risk factors; pathology; bladder cancer; bladder tumor; risk factor; urinary bladder neoplasms; physiology; age; risk assessment; survival time; cancer center; disease severity; disease progression; lymph node; cystectomy; comorbidity; scoring system; aging; clinical decision making; multivariate analysis; carcinoma, transitional cell; bladder carcinoma; statistical model; transitional cell carcinoma; institutional care; age adjusted charlson comorbidity index
Journal Title:	Cancer
Volume:	112
Issue:	11
ISSN:	0008-543X
Publisher:	Wiley Blackwell
Date Published:	2008-06-01
Start Page:	2384
End Page:	2392
Language:	English
DOI:	10.1002/cncr.23462
PUBMED:	18404699
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-52049099393&partnerID=40&md5=3d5cf453c52309a7cefb5b5ad7b327c9
Notes:	--- - "Cited By (since 1996): 34" - "Export Date: 17 November 2011" - "CODEN: CANCA" - "Source: Scopus"

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