Originally published as JCO Early Release 10.1200/JCO.2009.22.4758 on August 3 2009

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Predictive Capacity of Three Comorbidity Indices in Estimating Mortality After Surgery for Colon Cancer

From the Departments of Epidemiology, Pathology, Preventive Medicine, Biostatistics, and Medicine, University of Alabama at Birmingham, Birmingham, AL; and the Department of Surgery, Morehouse School of Medicine, Atlanta, GA.

Corresponding author: Upender Manne, MS, PhD, Department of Pathology, University of Alabama at Birmingham, 1922 7th Ave S, Birmingham, AL 35294; e-mail: manne{at}uab.edu.

Purpose Although, for patients with cancer, comorbidity can affect the timing of cancer detection, treatment, and prognosis, there is little information relating to the question of whether the choice of comorbidity index affects the results of studies. Therefore, to compare the association of comorbidity with mortality after surgery for colon cancer, this study evaluated the Adult Comorbidity Evaluation-27 (ACE-27), the National Institute on Aging (NIA) and National Cancer Institute (NCI) Comorbidity Index, and the Charlson Comorbidity Index (CCI).

Patients and Methods The study population consisted of colon cancer patients (N = 496) who underwent surgery at the University of Alabama at Birmingham Hospital from 1981 to 2002. Hazard ratios (HRs) with 95% CIs were obtained using the method of Cox proportional hazards for the three comorbidity indices in predicting overall and colon cancer–specific mortality. The point estimates obtained for comorbidity and other risk factors across the three models were compared.

Results For each index, the highest comorbidity burden was significantly associated with poorer overall survival (ACE-27: HR = 1.63; 95% CI, 1.24 to 2.15; NIA/NCI: HR = 1.83; 95% CI, 1.29 to 2.61; CCI: HR = 1.46; 95% CI, 1.14 to 1.88) as well as colon cancer–specific survival. For the other risk factors, there was little variation in the point estimates across the three models.

Conclusion The results obtained from these three indices were strikingly similar. For patients with severe comorbidity, all three indices were statistically significant in predicting shorter survival after surgery for colon cancer.

Supported in part by Grants No. U54-CA118948 and RO1-CA98932-01 (U.M.) from the National Institutes of Health (NIH)/National Cancer Institute (NCI). Also supported by an NIH/NCI Grant No. 5-R25-CA47888 (R.B.H.) as part of the Cancer Prevention and Control Training Program.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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