The Age-Adjusted Charlson Comorbidity Index Predicts Prognosis in Elderly Cancer Patients

Figures & data

Table 1 The Age-Adjusted Charlson Comorbidity Index

Point	Comorbidity
1	Myocardial infarction, heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disorder, peptic ulcer disease, mild liver disease, diabetes mellitus without complications
2	Diabetes mellitus with complications, moderate-to-severe renal disease, hemiplegia, leukaemia, lymphoma, tumor without metastases
3	Moderate-to-severe liver disease
6	Metastatic solid tumors, acquired immunodeficiency syndrome

Table 2 Demographic and Clinical Characteristics of the Patients

Characteristic	Low-ACCI (N=32)	High-ACCI (N=32)	Total (N=64)	P-value
Age (year)	88.69±5.86	86.50±6.22	87.59±6.10	0.1527
Gender				0.1685
Male, n (%)	29 (90.63%)	25 (78.13%)	54 (84.38%)
Female, n (%)	3 (9.37%)	7 (21.87%)	10 (15.62%)
ECOG				0.3087
1–2, n (%)	21 (65.62%)	17 (53.13%)	38 (59.37%)
3–4, n (%)	11 (34.38%)	15 (46.87%)	26 (40.63%)
Smoking				0.4513
Yes, n (%)	16 (50.00%)	13 (40.62%)	29 (45.31%)
No, n (%)	16 (50.00%)	19 (59.38%)	35 (54.69%)
Hypertension				0.1306
Yes, n (%)	21 (65.62%)	15 (46.87%)	36 (56.25%)
No, n (%)	11 (34.38%)	17 (53.13%)	28 (43.75%)
CHD				0.2057
Yes, n (%)	21 (65.62%)	16 (50.00%)	27 (42.19%)
No, n (%)	11 (34.38%)	16 (50.00%)	37 (57.81%)
Chemotherapy				0.3135
Yes, n (%)	16 (50.00%)	20 (62.50%)	36 (56.25%)
No, n (%)	16 (50.00%)	12 (37.05%)	28 (43.75%)
Radiotherapy				1.000
Yes, n (%)	6 (18.75%)	6 (18.75%)	12 (18.75%)
No, n (%)	26 (81.25%)	26 (81.25%)	52 (81.25%)
Cancer type				0.3031
Gastrointestinal, n (%)	12 (37.5%)	17 (53.13%)	29 (45.31%)
Respiratory, n (%)	10 (31.25%)	10 (31.25%)	20 (31.25%)
Urinary, n (%)	7 (21.88%)	2 (6.25%)	9 (14.06%)
Other, n (%)	3 (9.37%)	3 (9.37%)	6 (9.38%)
CEA (ng/mL)	9.82±24.60	25.08±62.03	17.57±47.71	0.2041
HbA1c (%)	6.08±0.96	6.77±1.46	6.39±1.25	0.0589
Hb (g/L)	117.20±22.48	106.70±27.38	111.93±25.41	0.0981
PLT (*10^9/L)	180.10±75.17	174.40±68.54	177.28±71.41	0.7529
Alb (g/L)	36.14±6.75	34.41±4.95	35.28±5.94	0.2458
Cr (umol/L)	84.37±36.21	103.50±86.53	93.92±66.50	0.2539

Note: Data are expressed as mean ± SD or n (%).

Abbreviations: ACCI, the age-adjusted Charlson comorbidity index; ECOG, Eastern Cooperative Oncology Group Performance Status; CHD, coronary heart disease; CEA, carcino-embryonic antigen; HbA1c, glycosylated hemoglobin type A1c; Hb, hemoglobin; PLT, platelet; Alb, albumin; Cr, creatinine.

Table 3 Analysis of Overall Survival Time

Variables	Parameter	Low-ACCI (N=32)	High-ACCI (N=32)
Events
Death	n (%)	11 (65.62)	31 (96.87)
Censor	n (%)	21 (34.38)	1 (3.13)
Overall survival (month)	Median (95% CI)	51.9 (34.1–84.0)	13.9 (10.5 −22.0)
	Log rank p-value		<0.001
	HR (95% CI)		3.801 (2.069 −6.982)
Survival rate
2 years (95% CI)		0.773 (0.581–0.885)	0.281 (0.140–0.441)
3 years (95% CI)		0.664 (0.464–0.804)	0.188 (0.076–0.337)
5 years (95% CI)		0.391 (0.211–0.567)	0.042 (0.003–0.169)

Abbreviations: ACCI, the age-adjusted Charlson comorbidity index; HR, hazard ratio.

Figure 1 Overall survival curve of high-ACCI vs low-ACCI group.

Table 4 Analysis of Progression-Free Survival Time

Variables	Parameter	Low-ACCI (N=32)	High-ACCI (N=32)
Events
Death	n (%)	11 (65.62)	31 (96.87)
Censor	n (%)	21 (34.38)	1 (3.13)
PFS (month)	Median (95% CI)	40.6 (20.1–52.4)	8.5 (6.1–13.6)
	Log rank p value		<0.001
	HR (95% CI)		3.885 (2.115–7.138)

Abbreviations: ACCI, the age-adjusted Charlson comorbidity index; HR, hazard ratio.

Figure 2 Progression free survival curve of high-ACCI vs low-ACCI group.

Table 5 The COX Proportional Hazards Model Analyses Predictors for OS

Variables	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age	0.974 (0.926–1.024)	0.2986	1.046 (0.930–1.177)	0.4506
Gender
Male	1.003 (0.469–2.144)	0.9949	0.784 (0.200–3.068)	0.7267
Female
ECOG
1–2
3–4	1.228 (0.700–2.155)	0.4730	0.984 (0.307–3.154)	0.9777
Smoking
Yes	1.155 (0.667–2.000)	0.6063	1.660 (0.743–3.705)	0.2163
No
Hypertension
Yes	0.636 (0.365–1.107)	0.1091	0.612 (0.279–1.341)	0.2200
No
CHD
Yes	0.628 (0.357–1.104)	0.1061	0.401 (0.108–1.482)	0.1705
No
Chemotherapy
Yes	1.031 (0.591–1.798)	0.9148	0.967 (0.463–2.016)	0.9279
No
Radiotherapy
Yes	0.893 (0.457–1.742)	0.7389	1.801 (0.629–5.152)	0.2728
No
ACCI	1.402 (1.226–1.604)	<0.001	1.456 (1.162–1.824)	0.0011
HbA1c	1.009 (0.756–1.346)	0.9540	0.805 (0.567–1.143)	0.2248
CEA	1.006 (1.001–1.011)	0.0234	1.008 (0.992–1.024)	0.3192
Alb	0.992 (0.945–1.042)	0.7529	1.008 (0.944–1.076)	0.8097

Abbreviations: ACCI, the age-adjusted Charlson comorbidity index; ECOG, Eastern Cooperative Oncology Group Performance Status; CHD, coronary heart disease; CEA, carcino-embryonic antigen; HbA1c, glycosylated hemoglobin type A1c; Alb, albumin.

Table 6 The COX Proportional Hazards Model Analyses Predictors for PFS

Variables	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age	0.963 (0.914–1.016)	0.1693	1.027 (0.908–1.162)	0.6667
Gender
Male	0.920 (0.430–1.965)	0.8290	0.576 (0.142–2.339)	0.4404
Female
ECOG
1–2
3–4	1.220 (0.687–2.166)	0.4967	1.181 (0.376–3.712)	0.7757
Smoking
Yes	1.191 (0.683–2.077)	0.5376	1.691 (0.776–3.683)	0.1862
No
Hypertension
Yes	0.619 (0.352–1.091)	0.0971	0.641 (0.292–1.411)	0.2695
No
CHD
Yes	0.597 (0.335–1.065)	0.0807	0.440 (0.132–1.468)	0.1816
No
Chemotherapy
Yes	1.092 (0.621–1.921)	0.7600	1.052 (0.499–2.218)	0.8944
No
Radiotherapy
Yes	0.904 (0.461–1.772)	0.7680	1.587 (0.538–4.680)	0.4027
No
ACCI	1.387 (1.212–1.587)	<0.001	1.353 (1.085–1.688)	0.0073
HbA1c	1.062 (0.800–1.410)	0.6769	0.917 (0.664–1.306)	0.6325
CEA	1.004 (0.999–1.010)	0.1465	1.006 (0.988–1.024)	0.5241
Alb	0.994 (0.944–1.045)	0.8022	1.004 (0.942–1.071)	0.8960

Abbreviations: ACCI, the age-adjusted Charlson comorbidity index; ECOG, Eastern Cooperative Oncology Group Performance Status; CHD, coronary heart disease; HR, hazard ratio; CI, confidence interval; CEA, carcino-embryonic antigen; HbA1c, glycosylated hemoglobin type A1c; Hb, hemoglobin; Alb, albumin.