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. 2021 Jul 28;16(7):e0255239.
doi: 10.1371/journal.pone.0255239. eCollection 2021.

A drug comorbidity index to predict mortality in men with castration resistant prostate cancer

Giuseppe Fallara  1   2   3 , Rolf Gedeborg  3 , Anna Bill-Axelson  3 , Hans Garmo  3   4 , Pär Stattin  3
Affiliations

A drug comorbidity index to predict mortality in men with castration resistant prostate cancer

Giuseppe Fallara et al. PLoS One. .

Abstract

Background: The Charlson Comorbidity Index is a poor predictor of mortality in men with castration resistant prostate cancer (CRPC). To improve this prediction, we created a comorbidity index based on filled prescriptions intended to be used in registry-based studies.

Materials and methods: In a population-based cohort of men with CPRC a drug comorbidity index (DCI-CRPC) was calculated based on prescriptions filled during a 365-day period before the date of CRPC diagnosis to predict mortality. Five risk categories for men with CRPC were defined based on PSA kinetics. Mortality rates were described by Kaplan-Meier curves. The predictive ability of the DCI-CRPC was compared in univariable models to that of the original DCI, derived from men in the general population, and to that of the Charlson Comorbidity Index.

Results: In 1,885 men with CRPC the median overall survival ranged from 3.0 years (95% confidence interval [CI] 2.8 to 3.4) in the first tertile of the DCI-CRPC, to 1.0 year (95% CI 0.9 to 1.1) in the third tertile of the DCI-CRPC. The index had higher discriminative ability (C-index 0.667) than the Charlson Comorbidity Index (C-index 0.508). The discriminative ability of the DCI-CRPC was highest in the subgroup with least aggressive cancer (C-index 0.651) and lowest in men with most aggressive cancer (C-index 0.618). The performance of the DCI-CRPC was comparable to that of the original DCI.

Conclusion: Our newly created comorbidity index using filled prescriptions predicted death in men with CRPC better than the Charlson Comorbidity Index.

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Conflict of interest statement

Region Uppsala has, on behalf of NPCR, made agreements on research projects with Astellas, Bayer, and Janssen based on NPCR and PCBaSe. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overall survival for 1885 men with castration resistant prostate cancer (CRPC), stratified in tertiles of the Drug Comorbidity Index developed for CRPC (DCI-CRPC), the original DCI, and the Charlson Comorbidity Index.
Fig 2
Fig 2. Overall survival in 1885 men with castration resistant prostate cancer (CRPC) in five risk categories and stratified in tertiles of the Drug Comorbidity Index for CRPC (DCI-CRPC).
See this image and copyright information in PMC

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