| Autor: |
de Boer AZ; Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Bastiaannet E; Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Putter H; Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Marang-van de Mheen PJ; Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Siesling S; Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands.; Department of Health Technology and Services Research, Technical Medical Center, University of Twente, 7522 NB Enschede, The Netherlands., de Munck L; Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands., de Ligt KM; Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands.; Department of Health Technology and Services Research, Technical Medical Center, University of Twente, 7522 NB Enschede, The Netherlands., Portielje JEA; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Liefers GJ; Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., de Glas NA; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands. |
| Abstrakt: |
Background : Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this study aimed to compare the predictive value of the Charlson comorbidity index for other-cause mortality with the use of a simple comorbidity count and to assess the impact of frequently occurring comorbidities. Methods : Surgically treated patients with stages I-III breast cancer aged ≥70 years diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. Competing risk analysis was performed to associate 5-year other-cause mortality with the Charlson index, comorbidity count, and specific comorbidities. Discrimination and calibration were assessed. Results : Overall, 7511 patients were included. Twenty-nine percent had no comorbidities, and 59% had a Charlson score of 0. After five years, in 1974, patients had died (26%), of which 1450 patients without a distant recurrence (19%). Besides comorbidities included in the Charlson index, the psychiatric disease was strongly associated with other-cause mortality (sHR 2.44 (95%-CI 1.70-3.50)). The c-statistics of the Charlson index and comorbidity count were similar (0.65 (95%-CI 0.64-0.65) and 0.64 (95%-CI 0.64-0.65)). Conclusions : The predictive value of the Charlson index for 5-year other-cause mortality was similar to using comorbidity count. As it is easier to use in clinical practice, our findings indicate that comorbidity count can aid in improving individualizing treatment in older patients with breast cancer. Future studies should elicit whether geriatric parameters could improve prediction. |
