Biomarkers and Risk Factors Detailed Analysis of Charlson Comorbidity Score as Predictor of Mortality After Radical Prostatectomy Michael Froehner, Rainer Koch, Rainer J. Litz, Sven Oehlschlaeger, Lars Twelker, Oliver W. Hakenberg, and Manfred P. Wirth OBJECTIVES To investigate the prognostic significance of the individual conditions contributing to the Charlson comorbidity score in patients selected for radical prostatectomy. METHODS A total of 1910 consecutive patients who underwent radical prostatectomy from 1992 to 2004 were studied. The Charlson score and its contributing single conditions were analyzed, and the patients were stratified into 3 age groups. Comorbid (noncancer), competing (nonprostate cancer), and overall mortality were used as the study endpoints. Mantel-Haenszel hazard ratios and Kaplan-Meier survival curves were calculated. Comparisons were made using the log-rank test. RESULTS Eleven comorbid conditions were significant predictors of any type of mortality in the different age groups. Eight conditions (congestive heart failure, peripheral vascular disease, cerebrovas- cular disease, diabetes, hemiplegia, moderate or severe renal disease, diabetes with end organ damage, moderate or severe liver disease, and metastatic solid tumor) were significant predictors of overall mortality. Two conditions (moderate or severe renal disease and metastatic solid tumor) were significant predictors of overall mortality in patients 63 years old. Five conditions (myocardial infarction, congestive heart failure, hemiplegia, moderate or severe renal disease, and diabetes with end organ damage) were significant predictors in patients aged 63-69 years, and 3 (peripheral vascular disease, cerebrovascular disease, and moderate or severe liver disease) were significant in patients aged 70 years. CONCLUSIONS In patients selected for radical prostatectomy, the Charlson score can also predict the mortality risk in those 70 years of age. The selection for good risks alters, however, the prognostic weight of the individual comorbid diseases in this age group. UROLOGY 72: 1252–1257, 2008. © 2008 Elsevier Inc. T he discrepancy between the incidence and mortal- ity of prostate cancer continues to raise concern about possible overdetection and overtreatment of insignificant tumors. 1 In addition to tumor-related vari- ables, age and comorbidity determine the clinical signif- icance of prostate cancer. 1,2 The Charlson score is prob- ably the most commonly used comorbidity measure in this setting. 3,4 It was developed to predict the 1-year mortality and consists of 19 conditions with different weights according to disease severity. 5 In patients con- sidered suitable for radical prostatectomy, short-term life- threatening diseases are eliminated by selection, leaving less severe cases with uncertain prognostic significance. Despite the popularity of the Charlson score, sparse data are available on the prognostic relevance of its individual contributing conditions in this setting. The identification of conditions with particular prognostic relevance and the appraisal of the effect of selection could support clinical decision-making for patients with early-stage prostate cancer. MATERIAL AND METHODS The study population consisted of 1910 consecutive patients who had undergone radical prostatectomy for clinically local- ized prostate cancer from December 1, 1992 to December 31, 2004. Institutional review board exemption was obtained. The mean age was 64 years (median 65, range 45-79). The mean prostate-specific antigen (PSA) value was 11.6 ng/mL (median 7.6) in patients without neoadjuvant hormonal treatment (n = 1556). The histopathologic tumor stage was available in 96% of the patients. Among them, 64% had organ-confined, lymph node-negative disease, 26% had locally advanced, lymph node- From the Departments of Urology, Medical Statistics and Biometry, and Anesthesiol- ogy, University Hospital “Carl Gustav Carus,” Technical University of Dresden, Dresden, Germany; and Department of Urology, University of Rostock, Rostock, Germany Reprint requests: Michael Froehner, M.D., Department of Urology, University Hospital “Carl Gustav Carus,” Technical University of Dresden, Fetscherstrae 74, Dresden D-01307 Germany. E-mail: Michael.Froehner@uniklinikum-dresden.de Submitted: March 7, 2008, accepted (with revisions): May 13, 2008 1252 © 2008 Elsevier Inc. 0090-4295/08/$34.00 All Rights Reserved doi:10.1016/j.urology.2008.05.037