Journal List > J Breast Cancer > v.13(4) > 1036233

Woo, Park, Kang, Kim, Lee, and Nam: Charlson Comorbidity Index as a Predictor of Long-Term Survival after Surgery for Breast Cancer: A Nationwide Retrospective Cohort Study in South Korea

Abstract

Purpose

The aim of this article was to evaluate the impact of the Charlson Comorbidity Index (CCI) on long-term survival after surgery for breast cancer in South Korea.

Methods

The study subjects were 29,562 women patients aged 20 years and older that underwent surgery for breast cancer between 2002 and 2005. The data were obtained from claims submitted to the National Health Insurance. All patients were censored at the follow-up cutoff date of June 30, 2006. Survival curves were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to explore the impact of CCI on all-cause mortality.

Results

After a follow-up time of 47 months, higher all-cause mortality was associated with an increasing CCI. In terms of the 4-year survival rate, among patients with CCI=1, it was 91.1%, among patients with CCI=2 it was 87.8%, and those patients with CCI≥3 it was 80.2%. Multivariate Cox proportional hazard analysis showed that CCI=1 (hazard ratios [HR], 1.10; 95% confidence interval [CI], 0.97-1.25), CCI=2 (HR, 1.61; 95% CI, 1.31-1.97) and CCI≥3 (HR, 2.27; 95% CI, 1.59-3.24), were associated with long-term survival.

Conclusion

CCI is a strong predictor of long-term survival after surgery for breast cancer. We recommend the use of a validated comorbidity index in the selection of patients for breast surgery.

Figures and Tables

Figure 1
Kaplan-Meier overall survival curve after surgery for breast cancer according to the Charlson Comorbidity Index (CCI).
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Table 1
Patients characteristic and dependant variables
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*Income level: division by insurance level (0-100), I: 26< (1Q), II: 1-26 (2Q), III: 0 (National Medical Aid beneficiaries); Type of operation: Major (radical or modified radical mastectomy), Minor (simple mastectomy, subcutaneous mastectomy, partial mastectomy); Metastasis were included regional or (and) distant site(s)/lymph node(s) involved. (C77-C80); §Hospital volume: very high, 3,454≤; high, 1,614-3,453; low, 870-1,613; very low, <870.

Table 2
Charlson comorbidity index scoring and prevalence of comorbid condition
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AIDS=acquired immune deficiency syndrome.

Table 3
Level of comorbidity according to CCI for study patients
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CCI=Charlson Comorbidity Index.

*p-value: statistical analysis was performed using the chi-squared test; Income level: division by insurance level (0-100), I: 26< (1Q), II: 1-26 (2Q), III: 0 (National Medical Aid beneficiaries); Type of operation: major (radical or modified radical mastectomy), minor (simple mastectomy, subcutaneous mastectomy, partial mastectomy); §Metastasis were included regional or (and) distant site(s)/lymph node(s) involved. (C77-C80); Hospital volume: very high, 3,454≤; high, 1,614-3,453; low, 870-1,613; very low, <870.

Table 4
Overall survival after surgery for breast cancer according to CCI
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CCI=Charlson Comorbidity Index; CI=confidence interval.

Table 5
Hazard ratio estimates of death and 95% confidence intervals from Cox's Proportional Hazards Model for CCI after surgery for breast cancer
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CCI=Charlson Comorbidity Index; HR=hazard ratio; CI=confidence interval.

*Model I: none-adjusted; Model II: adjusted for age, year of operation, income level; Model III: adjusted for age, year of operation, income level, range of operation, metastasis, and procedure volume of hospital; §p-value for trend from the Wald statistic; p-value from the Hosmer-Lemeshow type chi-square statistic.

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