Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer

Abstract

Introduction To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC). Method Data from patients with GC who underwent radical gastrectomy from January 2008 to December 2012 in Fujian Medical University Union Hospital were retrospectively analyzed. Patients were categorized into either high ACCI group or low ACCI group based on the effect of ACCI on long-term GC prognosis. 1:1 propensity score matching (PSM) was used to reduce confounding bias. To further analyze the impact of ACCI on the long-term prognosis of patients after radical gastrectomy, a nomogram was built based on the Cox proportional hazards regression model. Results A total of 1476 patients were included in the analysis. After PSM, there was no statistically significant differences in tumor location, tumor size and tumor stage between low ACCI group (429 cases) and high ACCI group (429 cases) (all P > 0.05). Before and after PSM, the incidence of postoperative complications in high ACCI group was significantly higher than that in low ACCI group ( P < 0.05). The 5-year overall survival rate (OS) in low ACCI group was significantly higher than that in high ACCI group. Multivariate analysis showed that ACCI was an independent risk factor for OS ( P < 0.05). The Harrell’s C-statistics (C-index) of TNMA, a prognostic evaluation system combining ACCI and TNM staging system, was significantly higher than that of TNM staging system in both the modeling and validation groups (all P < 0.05). Conclusions ACCI was an independent risk factor for the long-term prognosis of GC patients after radical gastrectomy that could effectively improve the predictive efficacy of the TNM staging system for GC. Electronic supplementary material The online version of this article (10.1186/s12893-019-0513-9) contains supplementary material, which is available to authorized users.

The Clinical Impact of the Age-adjusted Charlson Comorbidity Index on Esophageal Cancer Patients Who Receive Curative Treatment

“…In addition, the 5-year RFS was 83.1% in the low-ACCI group and 73.4% in the high-ACCI group (HR=1.44, 95%CI=1.15-1.80, p=0.001). Lin et al evaluated the clinical impact of ACCE in 1476 gastric cancer patients who received curative surgery (18). They reported that there were significant differences in the OS between the low-and high-ACCI groups.…”

“…Several studies have previously explored the appropriate cut-off value of ACCI in several cancers. In the gastrointestinal region, Lin et al set 3 as the cut-off value in 1476 gastric cancer patients, and Maezawa et al set 6 as the cut-off value in 2254 gastric cancer patients (17,18). In the hepato-biliary pancreatic cancer region, Qu et al set 4 as the cut-off value in 268 intrahepatic cholangiocarcinoma patients, and Takahara et al set 5 as the cut-off value in biliary tract cancer (22,23).…”

Challenges in the treatment of gastric cancer in the older patient

“…The Charlson Comorbidity Index (CCI) is a validated numerical measure of the burden of chronic disease, originally developed to predict prognosis of patients with comorbidities. The ageadjusted CCI (ACCI) has been demonstrated to predict the incidence of postoperative complications following radical gastrectomy for gastric cancer, with a high ACCI score an independent risk factor for the long-term prognosis of gastric cancer patients after surgery (30). This could prove a useful measure in the decision to undergo surgery and to plan the therapeutic strategy by the multidisciplinary team.…”

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

“…The older patients presented with the burden of cardiovascular, endocrine and renal co-morbidity far in excess of that seen in younger patients, as evidenced by a signi cantly higher CCI [14][15][16]. While a direct correlation has yet to be studied between aaCCI and morbidity and mortality following emergency cholecystectomy, strong evidence exists supporting aaCCI as a robust predictor of poor outcomes following elective gynecologic, oncologic gastrointestinal and emergency orthopedic surgery.…”

“…The role of frailty as an independent risk factor for adverse postoperative outcomes is also now emerging [10][11][12][13]. An ageadjusted Charlson co-morbidity index [14][15][16] has been recently validated, while limitations in the discriminating power of the prognostic p-POSSUM score have been recognised in the older patient [17]. management of these patients [18,19].…”