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      Association between Charlson comorbidity index and survival outcomes in patients with prostate cancer: A meta-analysis

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          Abstract

          Objective

          This meta-analysis aimed to assess the influence of comorbidity, as assessed by the Charlson comorbidity index (CCI), on survival outcomes in patients with prostate cancer (PCa).

          Methods

          We conducted a comprehensive search of the PubMed, Web of Science, and Embase databases to identify studies that examined the association between CCI-defined comorbidity and survival outcomes in PCa patients. We employed a random effect model to merge adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for survival outcomes.

          Results

          Sixteen studies reporting on 17 articles, which collectively included 457,256 patients. For the presence (CCI score ≥1) versus absence (CCI score of 0) of comorbidity, the pooled HR was 1.59 (95 % CI 1.43–1.77) for all-cause mortality, 0.98 (95 % CI 0.90–1.08) for PCa-specific mortality, and 1.88 (95 % CI 1.61–2.21) for other-cause mortality. When compared to a CCI score of 0, the pooled HR of all-cause mortality was 1.30 (95 % CI 1.18–1.44) for a CCI score of 1, 1.65 (95 % CI 1.37–2.00) for a CCI score ≥2, and 1.75 (95 % CI 1.57–1.95) for a CCI score ≥3. Additionally, the pooled HR of other cause mortality was 1.53 (95 % CI 1.41–1.67) for a CCI score of 1, 1.93 (95 % CI 1.74–2.75) for a CCI score ≥2, and 3.95 (95 % CI 2.13–7.34) for a CCI score ≥3.

          Conclusions

          Increased comorbidity, as assessed by the CCI, significantly predicts all-cause and other-cause mortality in patients with PCa, but not PCa-specific mortality. The risk of all-cause and other-cause mortality increases with the burden of comorbidity.

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          Most cited references41

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          Bias in meta-analysis detected by a simple, graphical test

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            A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

            The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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              The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

              Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                03 February 2024
                29 February 2024
                03 February 2024
                : 10
                : 4
                : e25728
                Affiliations
                [a ]Department of Urology, Affiliated Taizhou Second People's Hospital of Yangzhou University, Taizhou, 225500, China
                [b ]Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, 212002, China
                [c ]Department of General Surgery, Suzhou Hospital, Affiliated Hospital of Medical School Nanjing University, Suzhou, 215163, China
                Author notes
                []Corresponding author. Department of General Surgery, Suzhou Hospital, Affiliated Hospital of Medical School Nanjing University, No. 1 Lijiang Road, 215163, Suzhou, China. zouchenzhj@ 123456163.com
                [∗∗ ]Corresponding author. Cancer Institute, The Affiliated People's Hospital, Jiangsu University, No. 8 Dianli Road, 212002, Zhenjiang, China. jszjfanyu@ 123456163.com
                [1]

                Contribute equally to this work.

                Article
                S2405-8440(24)01759-6 e25728
                10.1016/j.heliyon.2024.e25728
                10881549
                38390166
                f0ba82a3-44ad-4121-9767-49c402f994c7
                © 2024 The Authors. Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 29 August 2023
                : 8 January 2024
                : 1 February 2024
                Categories
                Research Article

                charlson comorbidity index,mortality,prostate cancer,meta-analysis

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