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Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 26, pages 715–721 (2023)Cite this article

Subjects

Abstract

Purpose

Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP).

Materials and methods

We sampled 4857 men with prostate cancer treated with RP in the VA from 2000–2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality.

Results

Over median follow-up of 6.7 years (IQR 3.7–10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14–2.04), 2.11 (1.55–2.88), 2.36 (1.68–3.31), 3.61 (2.61–4.98), and 4.99 (3.58–6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26–9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations.

Conclusions

The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.

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Fig. 1: Higher PCCI score is associated with increased risk of long-term mortality outcomes.
Fig. 2: Higher PCCI score is associated with worse cancer outcomes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. University of California, San Diego School of Medicine, La Jolla, CA, USA

    Michelle S. Chen

  2. Section of Urology, Durham VA Medical Center, Durham, NC, USA

    Lauren E. Howard, Shannon Stock & Stephen J. Freedland

  3. Department of Urology, Duke University, Durham, NC, USA

    Lauren E. Howard

  4. Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA

    Shannon Stock

  5. Evergreen Health, Kirkland, WA, USA

    Anna Dolgner

  6. Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Stephen J. Freedland & Timothy J. Daskivich

  7. Division of Urology, West Los Angeles VA Medical Center, Los Angeles, CA, USA

    William Aronson

  8. Department of Urology, UCLA Medical Center, Los Angeles, CA, USA

    William Aronson

  9. Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA

    Martha Terris & Zachary Klaassen

  10. Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA

    Martha Terris & Zachary Klaassen

  11. Department of Urology, University of California, San Diego, CA, USA

    Christopher Kane

  12. Department of Urology, Oregon Health Sciences University, Portland, OR, USA

    Christopher Amling

  13. Department of Urology, University of California, San Francisco, CA, USA

    Matthew Cooperberg

  14. Section of Urology, San Francisco VA Medical Center, San Francisco, CA, USA

    Matthew Cooperberg

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Contributions

MSC. study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. LEH: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. SS: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. AD: study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. SJF: study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. WA: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. MT: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. ZK: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. CK: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. CA: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. MC: acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support. TJD: study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, technical or material support.

Corresponding author

Correspondence to Timothy J. Daskivich.

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Chen, M.S., Howard, L.E., Stock, S. et al. Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy. Prostate Cancer Prostatic Dis 26, 715–721 (2023). https://doi.org/10.1038/s41391-022-00550-5

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  • DOI: https://doi.org/10.1038/s41391-022-00550-5

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