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

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.