While all three comorbidity indices correlated significantly with OS in women with early-stage EC, AACCI was the only independent predictor of OS and should be considered for evaluating comorbidity in future endometrial cancer patients.
Sean Vance, MD, Meredith Mahan, Mohamed Elshaikh, MD; Henry Ford Hospital
PURPOSE/OBJECTIVES: The negative impact of medical comorbidity on survival endpoints in women with endometrial carcinoma (EC) is well known. Few validated comorbidity indices are available for clinical use-eg, the Charlson Comorbidity Index (CCI), age-adjusted Charlson Comorbidity Index (AACCI), and Adult Comorbidity Evaluation-27 (ACE-27). The study goal is to evaluate which index correlates best with survival endpoints in women with early-stage EC.
MATERIALS AND METHODS: For this institutional review board (IRB)-approved study, our prospectively maintained database of 1,920 women with endometrial cancer was reviewed. We identified 1,132 women with endometrioid carcinoma International Federation of Gynecology and Obstetrics (FIGO) stages I–II who underwent hysterectomy from 1987–2011. The three comorbidity indices at the time of hysterectomy were retrospectively calculated by physician chart review. Univariate and multivariate modeling with Cox regression analysis was used to determine the significant predictors of survival endpoints. Kaplan-Meier and log-rank test methods were used to evaluate survival outcomes.
RESULTS: After a median follow-up of 60 months, 262 deaths were recorded (42 from EC [16%] and 220 [84%] from other causes). For each of the studied comorbidity indices, the highest scores correlated significantly with poorer overall survival (OS). The hazard ratio of death from any cause was 3.92 (95% confidence interval [CI], 2.95–5.20) for AACCI, 2.25 (95% CI, 1.73–2.94) for CCI, and 1.57 (95% CI, 1.23–2.01) for ACE-27. Lymphovascular space involvement, tumor grade, lower uterine segment involvement, and AACCI were independent predictors of OS. None of the three comorbidity indices was significantly predictive of disease-specific or recurrence-free survival.
CONCLUSIONS: While all three comorbidity indices correlated significantly with OS in women with early-stage EC, AACCI was the only independent predictor of OS and should be considered for evaluating comorbidity in future endometrial cancer patients.
Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org