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Comparison of Charlson comorbidity index and Kaplan–Feinstein index in patients with stage I lung cancer after surgical resection

^a Division of Thoracic Surgery, Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
^b Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Received 19 June 2007; received in revised form 6 August 2007; accepted 3 September 2007.

^_* Corresponding author. Address: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan. Tel.: +886 2 28757546; fax: +886 2 28731488. (Email: hsuhs{at}vghtpe.gov.tw).

Objective: We sought to determine whether Charlson comorbidity index (CCI) or Kaplan–Feinstein index (KFI) is a better predictor of prognosis in patients with stage I NSCLC after surgical resection. Methods: A retrospective study of medical records of 426 patients with stage I lung cancer having complete surgical resection from 1995 to 2000 was performed. Data collected included age, gender, smoking history, resection type, pleural invasion status, and tumor type and size. Comorbidity score was determined using Charlson comorbidity index and Kaplan–Feinstein index. Both univariate and multivariate analyses were used to evaluate prognostic factors. Results: Three hundred and twenty-eight male (76.99%) and 98 female (23.01%) patients had a mean age of 67.07 years (range 19–88 years). Median duration of follow-up was 60.32 months. Total follow-up rate was 95.1%. Distribution of CCI score was: 0, 236 (55.40%); 1, 112 (26.29%); 2, 78 (18.31%). Overall KFI score was: none, 247 (57.98%); mild, 126 (29.58%); moderate, 43 (10.09%); and severe, 10 (2.35%). In univariate analyses, patients aged 65 years, male, smokers, CCI score 2, extensive resection and pathological stage IB cancer had poorer 5-year survival. In multivariate logistic regression analysis, age 65 years, pneumonectomy, CCI score 2, and stage IB cancer were independent prognostic factors for poorer 5-year survival. Conclusions: Patients with CCI 2 had higher perioperative mortality and death from non-cancer causes after surgery compared to patients with CCI <2. However, KFI score had no impact on operative mortality and non-cancer death during follow-up.

Key Words: Comorbidity • Charlson score • Kaplan–Feinstein index • Lung cancer • Survival analysis