通过将目标试验模拟与随机对照试验结果进行基准比较，量化两个新合并症指数调整混杂因素的能力。观察性研究包括来自瑞典前列腺癌数据库 5.0 的 18 316 名男性，他们在 2008 年至 2019 年间被诊断患有前列腺癌，接受初次根治性前列腺切除术 (n=14 379) 或放疗 (n=3937)。使用两种新的合并症指数（基于多维诊断的合并症指数（MDCI）和药物合并症指数（DCI））调整合并症后对调整后的全因死亡风险的影响与查尔森合并症指数的调整进行了比较(CCI)。放疗后的死亡风险高于根治性前列腺切除术（HR=1.94；95% CI：1.70 - 2.21）。调整年龄、癌症特征和 CCI 后，差异减小（HR=1.32，95% CI：1.06 - 1.66）。对两个新合并症指数的调整进一步缩小了差异（HR 1.14，95% CI 0.91 - 1.44）。模拟一项假设的实用性试验，其中也包括具有任何类型基线合并症的老年男性，在很大程度上证实了这些结果（HR 1.10；95% CI 0.95 - 1.26）。使用两个新指数对合并症进行调整提供了可比的全因死亡风险与随机对照试验的结果一致。在更广泛的研究人群中也看到了类似的结果，更能代表临床实践。版权所有 © 2024。由 Elsevier Inc. 出版。

To quantify the ability of two new comorbidity indices to adjust for confounding, by benchmarking a target trial emulation against the randomized controlled trial result.Observational study including 18 316 men from Prostate Cancer data Base Sweden 5.0, diagnosed with prostate cancer between 2008 and 2019 and treated with primary radical prostatectomy (n=14 379) or radiotherapy (n=3937). The effect on adjusted risk of death from any cause after adjustment for comorbidity by use of two new comorbidity indices, the Multidimensional Diagnosis-based Comorbidity Index (MDCI) and the Drug Comorbidity Index (DCI), were compared to adjustment for the Charlson Comorbidity Index (CCI).Risk of death was higher after radiotherapy than radical prostatectomy (HR=1.94; 95% CI: 1.70 - 2.21). The difference decreased when adjusting for age, cancer characteristics, and CCI (HR=1.32, 95% CI: 1.06 - 1.66). Adjustment for the two new comorbidity indices further attenuated the difference (HR 1.14, 95% CI 0.91 - 1.44). Emulation of a hypothetical pragmatic trial where also older men with any type of baseline comorbidity were included, largely confirmed these results (HR 1.10; 95% CI 0.95 - 1.26).Adjustment for comorbidity using two new indices provided comparable risk of death from any cause in line with results of a randomized controlled trial. Similar results were seen in a broader study population, more representative of clinical practice.Copyright © 2024. Published by Elsevier Inc.