Impact of Age-Adjusted Charlson Comorbidity score on outcomes for patients with early-stage endometrial cancer
Impact of Age-Adjusted Charlson Comorbidity score on outcomes for patients with early-stage endometrial cancer
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DOI：
10.1016/j.ygyno.2013.10.007
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发表时间：
2013-12-01
影响因子：
4.7
通讯作者：
Elshaikh, Mohamed A.
中科院分区：
文献类型：
--
作者：
Robbins, Jared R.;Gayar, Omar H.;Elshaikh, Mohamed A.
目标.目的：探讨子宫内膜癌患者术后早期应用AAC（Charlson Comorbidity Index）评分对生存结局的影响。IRB批准后，通过医师病历审查，对671例2009年FIGO I-II期类腺瘤样腺癌患者行子宫切除术时的AAC评分进行回顾性制表。根据AAC评分将患者分组如下：0-1（n = 204）、2-3（n = 293）和>3（n = 174）。采用Kaplan-Meier和log-rank检验方法，单变量和多变量模型结合考克斯回归分析，确定各生存终点的显著性预测因素。在中位随访85个月后，记录了225例死亡（34例死于EC，191例死于其他原因），7年总生存率（OS）和疾病特异性生存率（DSS）分别为77.6%和94.0%。根据MC分组，7年OS、DSS和无复发生存期（RFS）分别为：MC 0-1为92.9%、96.8%和94.9%; MC 2-3为81.7%、95.3%和89.8%：MC > 3分别为56%、88.2%和84.9%（p < 0.0001，p = 0.005和p = 0.013）。多因素分析显示，较高的AAC评分、肿瘤分级、子宫段受累较低和淋巴血管间隙侵犯是OS较短的独立预测因子，而对于DSS和RFS，较高的肿瘤分级和淋巴血管间隙侵犯是预后较差的显著预测因子，但较高的MC评分不是。在预测早期子宫内膜样癌患者的总体生存结局方面，合并症评分与病理学特征同样重要。较高的MC评分准确地预测了较差的OS。在子宫内膜癌的前瞻性临床试验中应考虑Comorbian评分。(C)2013 Elsevier Inc. All rights reserved.
Objectives. To To determine the impact of Age-Adjusted Charlson Comorbidity (AAC) index score on survival outcomes for patients with early stage endometrial cancer.Methods. After IRB-approval, AAC score at time of hysterectomy was retrospectively tabulated by physician chart review for 671 patients with 2009 FIGO stage I-II endometrioid adenocarcinoma. Patients were grouped based on their AAC scores as follows: 0-1 (n = 204), 2-3 (n = 293) and >3 (n = 174). Kaplan-Meier and log-rank test methods and univariate and multivariate modeling with Cox regression analysis was used to determine significant predictors of each survival endpoint.Results. After a median follow-up of 85 months, 225 deaths were recorded (34 from EC and 191 from other causes) with a 7-year Overall (OS) and Disease-specific survival (DSS) of 77.6% and 94.0%, respectively. Based on MC grouping, the 7-year OS, DSS, and Recurrence-free survival (RFS) were: 92.9%, 96.8%, and 94.9% for MC 0-1; 81.7%, 95.3%, and 89.8% for MC 2-3: and 56%, 88.2%, and 84.9% for MC > 3 (p < 0.0001, p = 0.005 and p = 0.013, respectively). On multivariate analyses, higher AAC score, tumor grade, lower uterine segment involvement, and lymphovascular space invasion were significantly independent predictors for shorter OS, while for DSS and RFS, higher tumor grade and lymphovascular space invasion were significant predictors of worse outcome, but higher MC score was not.Conclusions. Comorbidity score is as important as pathological features for predicting overall survival outcomes in patients with early-stage endometrioid endometrial carcinoma. Higher MC scores accurately predicted for worse OS. Comorbidity score should be considered in prospective clinical trials of endometrial carcinoma. (C) 2013 Elsevier Inc. All rights reserved.