Simplified cardiovascular index may be the best comorbidity index for clinical use in prediction of mortality for renal cancer patients

Dennis Boynton; Sabrina L Noyes; Adharsh Murali; Henry Peabody; Andrew Krumm; Karandeep Singh; Brian R Lane

doi:10.1016/j.urolonc.2024.01.004

Simplified cardiovascular index may be the best comorbidity index for clinical use in prediction of mortality for renal cancer patients

Urol Oncol. 2024 Mar;42(3):72.e1-72.e8. doi: 10.1016/j.urolonc.2024.01.004. Epub 2024 Jan 18.

Authors

Dennis Boynton¹, Sabrina L Noyes², Adharsh Murali³, Henry Peabody², Andrew Krumm⁴, Karandeep Singh⁵, Brian R Lane⁶

Affiliations

¹ Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI.
² Division of Urology, Corewell Health West, Grand Rapids, MI.
³ Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
⁴ Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.
⁵ Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.
⁶ Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Urology, Corewell Health West, Grand Rapids, MI. Electronic address: brian.lane@corewellhealth.org.

PMID: 38242826
DOI: 10.1016/j.urolonc.2024.01.004

Abstract

Objective: Understanding the relationship between comorbidities and life expectancy is important in cancer patients who carry risks of cancer and noncancer-related mortality. Comorbidity indices (CI) are tools to provide an objective measure of competing risks of death. We sought to determine which CI might be best incorporated into clinical practice for patients with suspected renal cancer.

Materials and methods: 1572 patients diagnosed with renal masses (stage I-IV) between 1998 and 2016 were analyzed for this study. Patient data were gathered from a community-based health center. Comorbidities were evaluated individually, and with 1 of 4 CI: Charlson (CCI), updated CCI (uCCI), age-adjusted CCI (aCCI), and simplified cardiovascular index (CVI). Cox-proportional hazard analysis of all-cause mortality was performed using the four CI, adjusting for the 4 CI, adjusting for age, gender, race, tumor size, and tumor stage.

Results: Univariable analyses revealed the four CI were significant predictors of mortality (P < 0.05), as were age, gender, tumor size, and stage. Comorbid conditions at diagnosis included hypertension (47.8%), diabetes mellitus (47.2%), coronary artery disease (41.1%), chronic kidney disease (31.8%), peripheral vascular disease (8.0%), congestive heart failure (5.7%), chronic obstructive pulmonary disease (5.7%), and cerebrovascular disease (2.0%). When analyzing the 4 CI in multivariable survival analyses accounting for factors available at diagnosis, and analyses incorporating pathologic and recurrence data, only CVI score and uCCI remained statistically significant (P < 0.05). Limitations of this work are the retrospective nature of data collection and data from a single institution, limiting the generalizability.

Conclusion: Increasing comorbidity, age, tumor size, and cM stage are predictors of ACM for suspected renal cancer patients. CVI appears to provide comparable information to various iterations of CCI (uCCI, aCCI) while being the simplest to use. Utilization of CVI may assist clinicians and patients when considering between interventional and noninterventional approaches for suspected renal cancer.

Keywords: CKD; Comorbidity; GFR; Kidney neoplasms; Proteinuria.

MeSH terms

Carcinoma, Renal Cell*
Comorbidity
Diabetes Mellitus*
Humans
Kidney Neoplasms*
Retrospective Studies