The age-adjusted Charlson comorbidity index as a predictor of overall survival of surgically treated non-metastatic clear cell renal cell carcinoma

• DOI: 10.1007/s00432-019-03042-7
• Publication Date: 2019-10-12T07:52:04Z
• Authors: 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
• Keywords: Log-rank test; Charlson comorbidity index; Kidney cancer

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.