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.
Journal of cancer research and clinical oncology. 2019 Oct 12 [Epub ahead of print]
Ho Won Kang, Sung Min Kim, Won Tae Kim, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim, Eu Chang Hwang, Seok Ho Kang, Sung-Hoo Hong, Jinsoo Chung, Tae Gyun Kwon, Hyeon Hoe Kim, Cheol Kwak, Seok-Soo Byun, Yong-June Kim, KORCC (KOrean Renal Cell Carcinoma) Group
Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea., Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, South Korea., Department of Urology, Korea University School of Medicine, Seoul, South Korea., Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea., Department of Urology, National Cancer Center, Goyang, South Korea., Department of Urology, Kyungpook National University College of Medicine, Daegu, South Korea., Department of Urology, Seoul National University College of Medicine, Seoul, South Korea., Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Kyunggi-do, 463-707, South Korea. ., Department of Urology, Chungbuk National University College of Medicine, 1st Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, South Korea. .