Modified Charlson comorbidity index as a pre-operative selection tool for liver transplantation in elderly patients

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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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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Impact of the Charlson Comorbidity Index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma: a multicenter retrospective study

Journal of Gastroenterology ◽

10.1007/s00535-019-01583-9 ◽

2019 ◽

Vol 54 (10) ◽

pp. 871-880 ◽

Cited By ~ 3

Author(s):

Keiichiro Nakajo ◽

Seiichiro Abe ◽

Ichiro Oda ◽

Ryu Ishihara ◽

Masaki Tanaka ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Retrospective Study ◽

Esophageal Squamous Cell Carcinoma ◽

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Cell Carcinoma ◽

Squamous Cell ◽

Treatment Strategy ◽

Charlson Comorbidity Index ◽

Comorbidity Index

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Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?

BJU International ◽

10.1111/j.1464-410x.2008.08275.x ◽

2009 ◽

Vol 103 (11) ◽

pp. 1492-1495 ◽

Cited By ~ 33

Author(s):

Kevin M. O’Connor ◽

Niall Davis ◽

Gerry M. Lennon ◽

David M. Quinlan ◽

David W. Mulvin

Keyword(s):

Elderly Patients ◽

Charlson Comorbidity Index ◽

Renal Masses ◽

Comorbidity Index ◽

Surgery In Elderly

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Charlson Comorbidity Index Is An Independent Prognostic Factor Among Elderly Patients with Diffuse Large B-Cell Lymphoma (DLBCL).

Blood ◽

10.1182/blood.v114.22.3923.3923 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3923-3923

Author(s):

Jin Takeuchi ◽

Atsuko Hojo

Keyword(s):

Elderly Patients ◽

Charlson Comorbidity Index ◽

Conflicts Of Interest ◽

Risk Group ◽

International Prognostic Index ◽

B Cell Lymphoma ◽

Poor Risk ◽

Risk Patients ◽

Comorbidity Index ◽

Good Risk

Abstract 3923 Poster Board III-859 Introduction Wide use of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has improved the clinical outcome for elderly patients with DLBCL; however, a higher prevalence of coexisting disorders remains a problem. Correlation between their comorbidities and prognosis has not yet been well investigated. Patients and methods We retrospectively analyzed all patients over 65 years old who had been newly diagnosed with DLBCL at our institution from 2001 to 2008. To assess their comorbid medical status, we calculated the Charlson Comorbidity Index (CCI) for patient excluding primary disease. Prognostic factors were identified by Cox proportional hazards regression model. We classified patients into a low CCI group (CCI 0-1) and a high CCI group (CCI 2 or higher). Kaplan-Meyer curves for each group were evaluated by logrank test. Results A total of 80 patients were enrolled in this analysis. The median age was 73 (range 66-90) and the median observation period was 28 months (range 4-90 months). 62 patients (77.5%) were treated with R-CHOP, 15 (18.6%) underwent some other regimen, and 3 (3.8%) were given best supportive care only. According to revised International Prognostic Index (r-IPI), 43 patients were in the good risk group and the others were in the poor risk group. The estimated 3 year over all survival (OS) rate for these groups were 90% and 45% (p<0.0001). As for CCI, 14 patients (17.5%) were assigned to the high CCI group. Multivariate analysis revealed high CCI was associated with worse OS, while independent of r-IPI [Hazard Ratio (HR) 3.20, 95% Confidence interval (CI) 1.28-7.41, p=0.0145]. Among r-IPI poor risk patients, the high CCI group was inferior to the low CCI group for the 3 year OS rate (14% vs 56% p=0.0358), whereas this was not significant among r-IPI good risk patients (69% vs 94% p=0.0617). Conclusions Among elderly patients with DLBCL, high CCI is independently associated with poor survival. Patients having both poor r-IPI and high CCI may need discrete strategies. Disclosures: No relevant conflicts of interest to declare.

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Prognostic Factors and Treatment Results in Elderly Patients with Aggressive B-Cell Lymphoma: A Geltamo Observational Study

Blood ◽

10.1182/blood.v126.23.1508.1508 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1508-1508

Author(s):

Emilia Pardal ◽

Eva Diez-Baeza ◽

Eva González-Barca ◽

Tomas Garcia-Cerecedo ◽

Encarna Monzo ◽

...

Keyword(s):

Elderly Patients ◽

B Cell ◽

Geriatric Assessment ◽

Charlson Comorbidity Index ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Malignant Neoplasms ◽

Comorbidity Index ◽

Very High ◽

Aggressive B Cell Lymphoma

Abstract Introduction: Diffuse large B-cell lymphoma (DLBCL) is one of the most common malignant neoplasms in elderly patients, potentially curable when optimum treatment is administered. The combination of rituximab with CHOP chemotherapy (R-CHOP) is considered standard for these patients, but randomized studies published to date are limited to the range of age from 60 to 80 years, so that in patients over this age treatment election is not so clear, usually opting for palliative treatment or a "full" treatment at a reduced dose. This retrospective study is primarily aimed to analyze the influence of the type of treatment and comorbidity scales in overall survival (OS) of a large series of patients >80 years with aggressive B-cell lymphoma. Methods: Eligible patients were aged ≥ 80 years, diagnosed of DLBCL, follicular lymphoma grade 3B or transformed lymphoma. The main patient characteristics were obtained retrospectively from the medical records, including a complete geriatric assessment (CGA, "comprehensive geriatric assessment") and the Charlson comorbidity index. The Ethics Committee of the University Hospital of Salamanca approved the study. Results: 288 patients from 19 GELTAMO hospitals were registered in the study, of which 234 (60% women) were evaluable and have been included in this preliminary analysis. The median age was 84 years (80-94) and the vast majority (94%) were DLBCL. According to the Charlson index, 65% of patients were low-intermediate risk, and according to CGA, 63% of patients were considered "fit". A higher proportion (60% v 44%, p = 0.03) of patients with low or intermediate comorbidity index were treated with a curative intent (CHOP +/- rituximab), as compared with patients with high or very high index. With a median follow up of 41 (range 9-142) months, the median OS was 11.5 months (33% estimated at 3 years). The median OS for patients treated with R-CHOP-like (N=96) was 35.3 months, significantly better (p <0.001) than those achieved with CHOP-like (n=23, 7.9 months), R-CVP (n=20, 6.9 months) or cyclophosphamide- prednisone +/- vincristine (n=69, 6.2 months). Charlson comorbidity index and CGA scale also had a significant influence on OS (median of 14.6 vs. 6.1 months for patients with low or intermediate versus high or very high risk, p = 0.006; and 18 vs 6.6 months for patients "fit" versus "non-fit", p = 0.006). In the multivariate analysis, treatment with R-CHOP-like (RR = 0.4; 95% CI: 0.3-0.6) and IPI <3 (RR = 0.4; 95% CI: 0.3-0.6) had an independent positive influence on OS. Conclusions: In patients over 80 years with DLBCL, treatment with R-CHOP-like was associated with the best results in terms of OS. Therefore, its administration must be considered whenever possible. Disclosures Sancho: CELLTRION, Inc.: Research Funding.

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