Re: Can We Avoid Percutaneous Nephrolithotomy in High-Risk Elderly Patients Using the Charlson Comorbidity Index?

Background: The optimal treatment strategy for elderly patients with early gastric adenocarcinoma (EGAC) after non-curative endoscopic submucosal dissection (ESD) remains unclear. The purpose of this research was to explore the effectiveness of additional treatments after ESD and the factors affecting survival in elderly patients (≥60 years of age) with EGAC.Methods: A total of 639 elderly patients (≥60 years) treated with ESD for EGAC from 2006 to 2018 were retrospectively reviewed. Positive lymphatic infiltration, submucosal infiltration, and positive/indeterminate vertical resection margins are considered high risk factors in histology. According to the risk of lymph node metastasis in patients with EAGC and the treatment strategies adopted after ESD, patients were divided into three groups: there were 484 patients in group A with low risk, 121 patients in group B with high risk, without additional treatment, and 36 patients in group C with high risk, with additional treatment. The 5- and 8-year survival rate, as well as the prognostic factors of survival rate after ESD was studied.Results: The median follow-up time was 38, 40, and 49 months, respectively. There were 3, 4, and 3 deaths related to gastric adenocarcinoma in groups A, B, and C, while deaths from other diseases were 20, 5, and 3, respectively. There were significant differences in overall survival rates between groups (94.3; 86.4; 81.2%, p = 0.110), but there was no significant difference in disease-specific survival rates (98.4; 92.7; 92.4%, p = 0.016). In the multivariate analysis, the Charlson Comorbidity Index (CCI) ≥ 2 was an independent risk factor for death after ESD (hazard ratio 2.39; 95% confidence interval 1.20–4.77; p = 0.014).Conclusions: The strategy of ESD with no subsequent additional treatment for EGAC may be a suitable option for elderly patients at high risk, especially for CCI ≥ 2.

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Predicting Percutaneous Nephrolithotomy Outcomes and Complications in Elderly Patients Using Guy's Scoring System and Charlson Comorbidity Index

International Journal of Gerontology ◽

10.1016/j.ijge.2018.05.001 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-243

Author(s):

Jen-Shu Tseng ◽

Wun-Rong Lin ◽

Fang-Ju Sun ◽

Tsu-Feng Lin ◽

Wei-Kung Tsai ◽

...

Keyword(s):

Elderly Patients ◽

Percutaneous Nephrolithotomy ◽

Charlson Comorbidity Index ◽

Scoring System ◽

Comorbidity Index

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636 SHORT-TERM OUTCOME FOR HIGH-RISK PATIENTS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doab052.636 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Victor Plat ◽

Wessel Stam ◽

Boukje Bootsma ◽

Jennifer Straatman ◽

Thomas Klausch ◽

...

Keyword(s):

High Risk ◽

Propensity Score ◽

Propensity Score Matching ◽

Charlson Comorbidity Index ◽

Short Term ◽

Term Outcome ◽

High Risk Patients ◽

Short Term Outcome ◽

Risk Patients ◽

Comorbidity Index

Abstract Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection, however it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. Methods This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Results Of 5438 patients, 945 and 431 high-risk patients underwent TTE and THE respectively. After propensity score matching, mortality (6.3% vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0% vs 2.2%, P = 0.020). Conclusion Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.

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The relationship of Charlson comorbidity index and postoperative complications in elderly patients after partial or radical nephrectomy

African Journal of Urology ◽

10.1016/j.afju.2018.09.004 ◽

2018 ◽

Vol 24 (4) ◽

pp. 387-391

Author(s):

E. Becher ◽

P.García Marchiñena ◽

J. Jaunarena ◽

D. Santillán ◽

L. Pérez ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Charlson Comorbidity Index ◽

Radical Nephrectomy ◽

Comorbidity Index ◽

Relationship Of ◽

The Relationship

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Elderly Patients with Locally Advanced and Unresectable Non-Small-Cell Lung Cancer May Benefit from Sequential Chemoradiotherapy

Cancers ◽

10.3390/cancers13184534 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4534

Author(s):

Magdalena Zaborowska-Szmit ◽

Marta Olszyna-Serementa ◽

Dariusz M. Kowalski ◽

Sebastian Szmit ◽

Maciej Krzakowski

Keyword(s):

Lung Cancer ◽

Weight Loss ◽

Elderly Patients ◽

Charlson Comorbidity Index ◽

Older Patients ◽

Locally Advanced ◽

Small Cell ◽

Small Cell Lung ◽

Stage Iiia ◽

Comorbidity Index

Concurrent chemoradiotherapy is recommended for locally advanced and unresectable non-small-cell lung cancer (NSCLC), but radiotherapy alone may be used in patients that are ineligible for combined-modality therapy due to poor performance status or comorbidities, which may concern elderly patients in particular. The best candidates for sequential chemoradiotherapy remain undefined. The purpose of the study was to determine the importance of a patients’ age during qualification for sequential chemoradiotherapy. The study enrolled 196 patients. Older patients (age > 65years) more often had above the median Charlson Comorbidity Index CCI > 4 (p < 0.01) and Simplified Charlson Comorbidity Index SCCI > 8 (p = 0.03), and less frequently the optimal Karnofsky Performance Score KPS = 100 (p < 0.01). There were no significant differences in histological diagnoses, frequency of stage IIIA/IIIB, weight loss, or severity of smoking between older and younger patients. Older patients experienced complete response more often (p = 0.01) and distant metastases less frequently (p = 0.03). Univariable analysis revealed as significant for overall survival: age > 65years (HR = 0.66; p = 0.02), stage IIIA (HR = 0.68; p = 0.01), weight loss > 10% (HR = 1.61; p = 0.04). Multivariable analysis confirmed age > 65years as a uniquely favorable prognostic factor (HR = 0.54; p < 0.01) independent of lung cancer disease characteristics, KPS = 100, CCI > 4, SCCI > 8. Sequential chemoradiotherapy may be considered as favorable in elderly populations.

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Age-adjusted Charlson Comorbidity Index as a prognostic factor for radical prostatectomy outcomes of very high-risk prostate cancer patients

PLoS ONE ◽

10.1371/journal.pone.0199365 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0199365 ◽

Cited By ~ 6

Author(s):

Jae Won Park ◽

Dong Hoon Koh ◽

Won Sik Jang ◽

Joo Yong Lee ◽

Kang Su Cho ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Prognostic Factor ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Charlson Comorbidity Index ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Comorbidity Index ◽

Very High

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Surgery for elderly patients with resectable pancreatic cancer, a comparison with non-surgical treatments: a retrospective study outcomes of resectable pancreatic cancer

BMC Cancer ◽

10.1186/s12885-019-6255-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Hyeong Min Park ◽

Sang-Jae Park ◽

Sung-Sik Han ◽

Seoung Hoon Kim

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Retrospective Study ◽

Elderly Patients ◽

Surgical Resection ◽

Charlson Comorbidity Index ◽

Resectable Pancreatic Cancer ◽

Surgery Group ◽

Comorbidity Index ◽

High Charlson Comorbidity Index

Abstract Background We designed a retrospective study to compare prognostic outcomes based on whether or not surgical resection was performed in elderly patients aged(≥75 years) with resectable pancreatic cancer. Methods We retrospectively analyzed 49 patients with resectable pancreatic cancer (surgery group, resection was performed for 38 cases; no surgery group, resection was not performed for 11 cases) diagnosed from January 2003 to December 2014 at the National Cancer Center, Korea. Results There was no significant difference in demographics between the two groups. The surgery group showed significantly better overall survival after diagnosis than the no surgery group (2-year survival rate, 40.7% vs. 0%; log-rank test, p = 0.015). Multivariate analysis revealed that not having undergone surgical resection [hazard ratio (HR) 2.412, P = 0.022] and a high Charlson comorbidity index (HR 5.252, P = 0.014) were independent prognostic factors for poor overall survival in elderly patients with early stage pancreatic cancer. Conclusions In the present study, surgical resection resulted in better prognosis than non-surgical resection for elderly patients with resectable pancreatic cancer. Except for patients with a high Charlson comorbidity index, an aggressive surgical approach seems to be beneficial for elderly patients with resectable pancreatic cancer.

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