Comparison of scoring methods for ACE-27: Simpler is better

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• 作者：Dorina Kallogjeri^a ; Jay F. Piccirillo^a ; ^{piccirilloj@ent.wustl.edu} ; Edward L. Spitznagel Jr.^b ; Ewout W. Steyerberg^c
• 关键词：Comorbidity comorbid ailment ; Elderly ; Cancer patients ; Prognostic ; Survival
• 刊名：Journal of Geriatric Oncology
• 出版年：2012
• 期刊代码：pca13_18794068
• 类别：bio
• 出版时间：July, 2012
• 卷：3
• 期：3
• 页码：238-245
• 文件大小：266 K

摘要

Objective

To examine the prognostic value of different comorbidity coding schemes for predicting survival of newly diagnosed elderly cancer patients.

Materials and methods

We analyzed data from 8867 patients aged 65 years of age or older, newly diagnosed with cancer. Comorbidities present at the time of diagnosis were collected using the Adult Comorbidity Evaluation-27 index (ACE-27). We examined multiple scoring schemes based on the individual comorbidity ailments, and their severity rating. Harrell's c index and Akaike Information Criterion (AIC) were used to evaluate the performance of the different comorbidity models.

Results

Comorbidity led to an increase in c index from 0.771 for the base model to 0.782 for a model that included indicator variables for every ailment. The prognostic value was however much higher for prostate and breast cancer patients. A simple model which considered linear scores from 0 to 3 per ailment, controlling for cancer type, was optimal according to AIC.

Conclusion

The presence of comorbidity impacts on the survival of elderly cancer patients, especially for less lethal cancers, such as prostate and breast cancers. Different ailments have different impacts on survival, necessitating the use of different weights per ailment in a simple summary score of the ACE-27.