The Charlson age comorbidity index predicts prognosis in patients with resected pancreatic cancer

Asano, Tomonari; Yamada, Suguru; Fujii, Tsutomu; Yabusaki, Norimitsu; Nakayama, Goro; Sugimoto, Hiroyuki; Koike, Masahiko; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1016/j.ijsu.2017.01.115

Cited by 38 publications

(39 citation statements)

References 27 publications

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“…Besides this, age and differentiation grade were further incorporated into the novel model. Asano et al 27 had reported the role of age in the survival of resected PC patients. Surgery was considered as a giant damage to patients’ physical functions and immune system, which may lead to serious comorbidities and mortalities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic prediction between nomogram based on lymph node ratio and AJCC 8th staging system for patients with resected pancreatic head carcinoma: a SEER analysis

et al. 2018

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BackgroundThe prognosis of pancreatic carcinoma (PC) remains poor and the American Joint Committee on Cancer (AJCC) 8th staging system for survival prediction in PC patients after curative resection is still limited. Thus, the aim of this study is to refine a valuable prognostic model and novel staging system for PC with curative resection.MethodsThe data of 3,458 patients used in this study were retrieved from the Surveillance, Epidemiology, and End Results database registry of National Cancer Institute. The prognostic value of lymph node ratio (LNR) was analyzed in the primary cohort and prognostic nomogram based on the LNR was established to create a novel staging system. Then, analyses were conducted to evaluate the application of the formulated nomogram staging system and the AJCC 8th staging system. The predictive performance of model was further validated in the internal validation cohort.ResultsSignificant positive correlations were found between LNR and all factors except for surgical procedures. The results of univariate and multivariate analyses showed that LNR was identified as an independent prognostic indicator for overall survival (OS) in both primary and validation cohorts (all P < 0.001). A prognostic nomogram based on the LNR was formulated to obtain superior discriminatory abilities. Compared with the AJCC 8th staging system, the formulated nomogram staging system showed higher hazard ratios of stage II, III, and IV disease (reference to stage I disease) that were 1.637, 2.300, and 3.521, respectively, by univariate analyses in the primary cohort and the distinction between stage I, II, and III disease at the beginning or end of the survival curves was more apparent. All these results were further verified in the validation cohort.ConclusionLNR can be considered as a useful independent prognostic indicator for PC patients after curative resection regardless of the surgical procedures. Compared with the AJCC 8th staging system, the formulated nomogram showed superior predictive accuracy for OS and its novel staging system revealed better risk stratification.

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Section: Discussionmentioning

confidence: 99%

Comparison of prognostic prediction between nomogram based on lymph node ratio and AJCC 8th staging system for patients with resected pancreatic head carcinoma: a SEER analysis

et al. 2018

CMAR

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“…The preoperative Charlson age-comorbidity index (CACI) was calculated from available data as a measure of frailty and patients were dichotomized using a threshold of 4 points based on recent literature. 16–18 Pre- and postoperative carbohydrate antigen (CA) 19–9 values were obtained, when available. CA 19–9 values acquired at time of jaundice (total bilirubin > 5mg/dL) or later than 2 months postoperatively were excluded from analysis.…”

Section: Methodsmentioning

confidence: 99%

Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

et al. 2019

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Objectives: To establish an evidence-based cutoff to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. Summary Background Data: A clear definition of “early recurrence” after pancreatic ductal adenocarcinoma resection is currently lacking. Methods: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrencewere assessed with logistic regression models. Results: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P< 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P< 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0cm on computed tomography (OR 1.53) and CA 19–9 > 210U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19–9 > 37U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. Conclusion: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.

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“…A CACI score > 4 was predictive for increased duration of hospitalisation and risk of postoperative complications, and a threefold higher risk of death within the first year was found in patients with a CACI score ≥ 6. In 379 patients who underwent resection for PC, the CACI score was an independent prognostic factor for short‐ and long‐term outcome and patients with CACI < 4 had better compliance for postoperative adjuvant chemotherapy than patients with CACI ≥ 4 (Asano et al, ). In 194 patients with locally advanced PDAC treated with intraoperative radiotherapy combined with chemotherapy, a CACI of ≤ 3 and treatment with chemotherapy predicted improved OS (Cai et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Precautions exist when using scoring to control for comorbidities including missing weighting for particular comorbidities as well as uncertainty concerning comprehensiveness of the conditions (Elixhauser, Steiner, Harris, & Coffey, ). Higher CACI is associated with poorer OS in resected PC patients and patients with unresectable locally advanced PC treated with intraoperative radiotherapy (Asano et al, ; Cai et al, ; Dias‐Santos, Ferrone, Zheng, Lillemoe, & Fernández‐Del, ). There are no studies addressing specifically the prognostic value of CACI and its interplay with other risk factors in a real‐world cohort of PC patients undergoing adjuvant or palliative chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of Charlson’s Age‐Comorbidity Index and other risk factors in patients with pancreatic cancer

et al. 2020

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Objectives: Few studies have evaluated the impact of risk factors and comorbidity on overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).The aim was to investigate the prognostic importance of Charlson's age-comorbidity index (CACI) and other risk factors on prognosis in a clinical real-world cohort of PDAC patients. Methods:A total of 1,159 patients with PDAC who had received at least one cycle of adjuvant or palliative chemotherapy were included from the Danish BIOPAC study.We analysed OS according to CACI, tobacco smoking, alcohol intake, performance status (PS), BMI and diabetes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for OS using Cox proportional hazards regression. Results:At the end of follow-up, 994 (86%) patients had died. The median OS was 298 days for all patients (range 3-3010) and shortest in patients with stage IV. No association with short OS was seen for CACI > 2, diabetes, alcohol abuse, tobacco smoking, hypertension, and high BMI. Multivariate analysis showed that stage (IV vs. I: HR = 9.05, 95% CI 5.17-15.84), PS (2 vs. 0: HR = 3.67, 2.92-4.61) and treatment with angiotensin-converting enzyme inhibitors (yes vs. no: HR = 1.31, 1.06-1.61) were independent negative prognostic factors. Conclusions:We found that CACI, diabetes, tobacco smoking, alcohol abuse, hypertension, and high BMI were not associated with OS in a real-world cohort of patients with PDAC treated with chemotherapy. Only stage and PS were prognostic parameters. K E Y W O R D SAge-Comorbidity Index, BMI, Charlson, diabetes, pancreatic cancer, risk factors, survival S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.

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The Charlson age comorbidity index predicts prognosis in patients with resected pancreatic cancer

Abstract: The CACI was a significant independent predictor of prognosis and compliance for postoperative adjuvant chemotherapy in the resected pancreatic cancer.

Cited by 38 publications

References 27 publications

Comparison of prognostic prediction between nomogram based on lymph node ratio and AJCC 8th staging system for patients with resected pancreatic head carcinoma: a SEER analysis

Comparison of prognostic prediction between nomogram based on lymph node ratio and AJCC 8th staging system for patients with resected pancreatic head carcinoma: a SEER analysis

Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

Prognostic impact of Charlson’s Age‐Comorbidity Index and other risk factors in patients with pancreatic cancer

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