An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer
An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer
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DOI：
10.1016/j.juro.2015.01.081
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发表时间：
2015-07-01
影响因子：
6.6
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
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作者：
Daskivich, Timothy J.;Kwan, Lorna;Litwin, Mark S.
目的：准确估计预期寿命对于男性考虑早期前列腺癌的侵袭性与非侵袭性治疗至关重要。我们建立了一个年龄调整的合并症指数，预测其他原因死亡率的男性与prostate cancer.Materials和Methods：我们抽样1,598人连续诊断前列腺癌之间的1998年和2004年在西洛杉矶和长滩退伍军人事务部医院。我们在测试和验证队列中使用竞争风险回归来确定与诊断时年龄和PCCI评分相关的非前列腺癌相关（即其他原因）死亡率的风险。我们转换成一个10点的评分系统的风险，并计算2，5和10年的累积发病率的其他原因死亡率的年龄调整PCCI scores.Results：PCCI评分和年龄与类似的危险，其他原因死亡率的测试和验证队列。诊断时年龄每增加6岁，超过60岁相当于增加1个PCCI点。校正年龄后的PCCI评分，年龄校正的PCCI评分是其他原因死亡率的强预测。评分为0、1-2、3-4、5-6、7-9和10+时，其他原因死亡率与0的亚风险比为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）和43.2（95% CI 26.6-70.4）。其他原因死亡的10年累积发生率分别为10%、19%、35%、60%、79%和99%，respectively：年龄调整后PCCI强烈分层的长期，其他原因死亡的风险。它可以被纳入共同决策，以减少对老年人和慢性前列腺癌患者的过度治疗。
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.