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Open Access Research article

A combined index to classify prognostic comorbidity in candidates for radical prostatectomy

Michael Froehner1*, Anna-Elisa Kellner1, Rainer Koch2, Gustavo B Baretton3, Oliver W Hakenberg4 and Manfred P Wirth1

Author Affiliations

1 Departments of Urology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany

2 Department of Medical Statistics and Biometry, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany

3 Department of Pathology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany

4 Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany

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BMC Urology 2014, 14:28  doi:10.1186/1471-2490-14-28

Published: 29 March 2014

Abstract

Background

In patients with early prostate cancer, stratification by comorbidity could be of importance in clinical decision making as well as in characterizing patients enrolled into clinical trials. In this study, we investigated several comorbidity classifications as predictors of overall mortality after radical prostatectomy, searching for measures providing complementary prognostic information which could be combined into a single score.

Methods

The study sample consisted of 2205 consecutive patients selected for radical prostatectomy with a mean age of 64 years and a mean follow-up of 9.2 years (median: 8.6). Seventy-four patients with incomplete tumor-related data were excluded. In addition to age and tumor-related parameters, six comorbidity classifications and the body mass index were assessed as possible predictors of overall mortality. Kaplan-Meier curves and Mantel-Haenszel hazard ratios were used for univariate analysis. The impact of different causes of death was analyzed by competing risk analysis. Cox proportional hazard models were calculated to analyze combined effects of variables.

Results

Age, Gleason score, tumor stage, Charlson score, American Society of Anesthesiologists (ASA) physical status class and body mass index were identified a significant predictors of overall mortality in the multivariate analysis regardless whether two-sided and three-sided stratifications were used. Competing risk analysis revealed that the excess mortality in patients with a body mass index of 30 kg/m2 or higher was attributable to competing mortality including second cancers, but not to prostate cancer mortality.

Conclusion

Stratifying patients by a combined consideration of the comorbidity measures Charlson score, ASA classification and body mass index may assist clinical decision making in elderly candidates for radical prostatectomy.

Keywords:
Prostate cancer; Radical prostatectomy; Comorbidity; Overall survival; Competing mortality; ASA classification; Charlson score; Body mass index; Cox proportional hazard models