The age-adjusted Charlson comorbidity index as a predictor of overall survival of surgically treated non-metastatic clear cell renal cell carcinoma
No study has evaluated the prognostic impact of the age-adjusted Charlson comorbidity index (AACI) in those with renal cell carcinoma (RCC). This study aimed to evaluate the utility of the AACI for predicting long-term survival in patients with surgically treated non-metastatic clear cell RCC (ccRCC).
Data from 698 patients with non-metastatic ccRCC who underwent radical or partial nephrectomy as primary therapy from a multi-institutional Korean collaboration between 1988 and 2015 were retrospectively analyzed. Clinicopathological variables and survival outcomes of those with AACI scores ≤ 3 (n = 324), 4–5 (n = 292), and ≥ 6 (n = 82) were compared.
Patients with a high AACI score were older and more likely to be female. They were also more likely to have diabetes or hypertension, a worse Eastern Cooperative Oncology Group performance status, and lower preoperative hemoglobin, albumin, serum calcium, and serum total cholesterol levels. Regarding pathologic features, a high AACI score was associated with advanced stage. Kaplan–Meier analyses revealed that AACI ≥ 6 was associated with shorter cancer-specific (log-rank test, P < 0.001) and overall survival (log-rank test, P < 0.001), but not with recurrence-free survival (log-rank test, P = 0.134). Multivariate Cox regression analyses identified an AACI score as an independent predictor of overall survival (hazard ratio, 6.870; 95% confidence interval, 2.049–23.031; P = 0.002). The AACI score was a better discriminator of overall survival than the Charlson comorbidity index score.
AACI scores may enable more tailored, individualized management strategies for patients with surgically treated non-metastatic ccRCC.
KeywordsRenal cell carcinoma Nephrectomy Comorbidity Prognosis Survival
Conception and study design: HWK and YJK. Acquisition of data: SMK, WTK, and SJY. Statistical analysis: SMK, WTK and SJY. Drafting and writing of the manuscript: HWK. Revision and critical review of the manuscript: S-CL, W-JK, ECH, SHK, S-HH, JC, TGK, HHK, CK, S-SB, and Y-JK. Manuscript approval: all authors.
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2018R1D1A1B07043906).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
The study was approved by the relevant institutional review boards of the eight participating centers, and informed consent was waived by the board.
Informed consent was waived by the board.
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