MP32-15 COMPARISON OF THE PROSTATE CANCER COMORBIDITY INDEX AND AMERICAN ANESTHESIOLOGY ASSOCIATION SCORE IN PREDICTION OF MORTALITY IN MEN UNDERGOING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP32)1 Sep 2021MP32-15 COMPARISON OF THE PROSTATE CANCER COMORBIDITY INDEX AND AMERICAN ANESTHESIOLOGY ASSOCIATION SCORE IN PREDICTION OF MORTALITY IN MEN UNDERGOING RADICAL PROSTATECTOMY Michelle Chen, Lauren Howard, Shannon Stock, Anna Dolgner, Stephen Freedland, William Aronson, Martha Terris, Zachary Klaassen, Christopher Kane, Christopher Amling, Matthew Cooperberg, and Timothy Daskivich Michelle ChenMichelle Chen More articles by this author , Lauren HowardLauren Howard More articles by this author , Shannon StockShannon Stock More articles by this author , Anna DolgnerAnna Dolgner More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , William AronsonWilliam Aronson More articles by this author , Martha TerrisMartha Terris More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Timothy DaskivichTimothy Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002036.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate prediction of competing risks of mortality is a key component of prostate cancer treatment decision-making. We sought to compare the Prostate Cancer Comorbidity Index (PCCI) with the American Society of Anesthesiology (ASA) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). METHODS: We conducted an observational study of 4,857 men with prostate cancer treated with RP in the VA SEARCH database from 2000–2018. Risks of OCM, prostate cancer-specific mortality (PCSM), all-cause mortality (ACM), metastasis, and biochemical recurrence (BCR) by PCCI and ASA score were determined using Cox proportional hazards analysis. To compare risk discrimination, risks of OCM by PCCI were analyzed when stratified by ASA and vice versa. RESULTS: Our sample had a broad distribution of PCCI scores; 734 (15%), 1563 (32%), 996 (21%), 588 (12%), 559 (12%), and 417 (9%) men had PCCI scores of 1-2, 3-4, 5-6, 7-9, and 10+, respectively. ASA score had a narrow range, with 98% having scores of 2 or 3, requiring categorization by 1-2 vs. 3-4. Median follow up was 6.7 years (IQR 3.7-10.3). There was a stepwise increase in hazard of ACM and OCM with higher PCCI score (Figure 1). Men with PCCI 1-2, 3-4, 5-6, 7-9, and 10+ had hazards of OCM (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), respectively. Men with ASA scores of 3-4 had a 1.96-fold (95% CI 1.65-2.33) higher hazard of OCM than those with scores of 1-2. Increases in PCCI score were associated with greater risk of ACM and OCM within ASA subgroups (p<0.001), while higher ASA was not uniformly associated with greater risk of ACM and OCM in PCCI subgroups. Higher PCCI but not ASA was associated with worse cancer outcomes, most notably those with the highest scores. Hazards (95% CI) of BCR, metastasis, and PCSM were 1.48 (1.18–1.84), 3.21 (1.69–6.12), and 3.56 (1.36–9.30), respectively, for those with PCCI of 10+ (vs 0). CONCLUSIONS: The PCCI is predictive of long-term OCM after RP, with improved granularity compared to the ASA. The association of higher PCCI with worse cancer outcomes may reflect relationships of older age and poorer health with more aggressive disease. Source of Funding: AUA Summer Medical Student Fellowship © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e571-e571 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Lauren Howard More articles by this author Shannon Stock More articles by this author Anna Dolgner More articles by this author Stephen Freedland More articles by this author William Aronson More articles by this author Martha Terris More articles by this author Zachary Klaassen More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matthew Cooperberg More articles by this author Timothy Daskivich More articles by this author Expand All Advertisement Loading ...