Impact of the Charlson Comorbidity Index on Mortality in Patients With Primary Central Nervous System Lymphoma
Joyce Jimenez Zambrano1, Nishita Gaba3, Ramiz Kirmani3, Aarabhi Gurumoorthy4, Kayla Geyer4, Anu Gaba2
1Department of Neurology, 2Department of Hematology and Oncology, University of North Dakota/ Sanford Health, 3University of North Dakota, 4Sanford Health
Objective:
In the present study, we aimed to identify the impact of the age-adjusted Charlson Comorbidity Index (CCI) on mortality in patients with primary central nervous system lymphoma (PCNSL).
Background:
PCNSL is a rare and aggressive form of extranodal non-Hodgkin lymphoma that is typically confined to the brain, eyes, spinal cord, and cerebrospinal fluid. Identifying prognostic factors in PCNSL is imperative for patient stratification and management. CCI has been widely used for mortality prediction in solid cancer patients; however, there is limited evidence of its value in PCNSL.
Design/Methods:
This retrospective multicenter study analyzed patients over 18 years of age who were newly diagnosed with PCNSL between January 2007 to December 2022. The age-adjusted CCI was calculated at diagnosis to quantify comorbid burden. We used univariate and multivariate Cox regression models to identify predictors of mortality.
Results:
A total of 174 patients were screened, of whom 69 met the inclusion criteria for the study. Among the participants, 37 (53.6%) were female. The mean age at diagnosis was 62 years. The cohort was predominantly Caucasian (95.65%). The mean age-adjusted Charlson Comorbidity Index (CCI) score was 5.72. The median survival time for the cohort was 4.12 years. In the univariate analysis, a higher age-adjusted CCI score was significantly associated with increased mortality (HR = 1.33; 95% CI: 1.20–1.48; p < 0.0001). In the multivariate analysis, both elevated age-adjusted CCI scores and Eastern Cooperative Oncology Group Performance Status scores of 3–4 were independently associated with higher mortality. Higher methotrexate dose was associated with reduced mortality in univariate but not multivariate analysis. Delayed presentation from symptom onset was also linked to increased mortality in univariate analysis but lost significance in the multivariate model.
Conclusions:
CCI is a significant prognostic factor in patients with PCNSL, with higher scores at diagnosis corresponding to an increased risk of mortality.
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