Evaluation of Charlson comorbidity index as predictor of survival in stage II-III colorectal cancer patients treated with surgery and neoadjuvant/adjuvant chemotherapy: A single Institution observational study

Background

Comorbidity has a well documented detrimental effect on cancer survival, but it is difficult to disentangle its direct effect on survival from indirect effects via the influence on treatment choice. This study aimed to assess the impact of comorbidity on survival in colorectal cancer (CRC) patients who underwent similarly aggressive treatment.

Methods

230 CRC patients, 68 rectal (29.6%) and 162 colon cancer (70.4%) treated with surgical resection and neoadjuvant/adjuvant chemotherapy from December 2002 to December 2008 at Humanitas Cancer Center were reviewed. The key independent variable was the Charlson Comorbidity Index (CCI) score. The differences between groups for categorical data were tested by the Chi-square test. Actuarial survival curves were generated using the Kaplan–Meier method.

Results

The median follow-up was of 113 months (range 8.2-145). The median age of patients was 63 (range 37-78). Since all patients had a diagnosis of non-metastatic cancer, the minimum CCI score was 2. In the univariate analysis CCI score, measured as a continuous variable, was significantly associated with poorer progression-free survival (PFS) (HR 1.65, 95%CI 1.52–1.80, p 

Conclusions

In this retrospective study we found that a higher CCI score is associated with poorer outcome providing convincing evidence that CCI score is an important negative prognostic factor even after adjusting for other prognostic factors. Some patients with comorbidity may forego chemotherapy unnecessarily, increasing avoidable cancer mortality.

Clinical trial identification

Legal entity responsible for the study

Humanitas Clinical and Research Center

Funding

Humanitas Clinical and Research Center

Disclosure

All authors have declared no conflicts of interest.