Which conditions contributing to the Charlson score predict survival after radical prostatectomy?

Purpose: The Charlson score is likely to be the most frequently used comorbidity measure in prostate cancer. However, to our knowledge the individual prognostic significance of contributing conditions has not been previously studied in a radical prostatectomy sample. Materials and Methods: A total of 444 consecutive patients were entered into this study. The 19 conditions contributing to the Charlson score were obtained from the preoperative cardiopulmonary risk assessment and the hospital discharge document. Mantel-Haenszel hazard ratios were estimated for comorbid (noncancer) and overall survival. Thereafter, the Charlson score was refined by excluding conditions with low predictive value. Results: Mean followup was 5.9 years. Only 3 single conditions (congestive heart failure; peripheral vascular disease and severe renal disease) were significantly associated with excess overall mortality. Concerning comorbid mortality, in addition to these 3 diseases, chronic pulmonary disease was associated with increased risk. Refinement of the Charlson score improved the circumscription of patients at risk for premature death after radical prostatectomy. Conclusions: This study suggests that restricting the Charlson score to some clinically meaningful diseases may increase its usefulness in candidates for radical prostatectomy. The conventional Charlson score did not add clinically meaningful information supplementary to congestive heart failure, which is the most important single contributing condition.