Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients

dc.contributor.authorBINDER, Pratibha S
dc.contributor.authorPEIPERT, Jeffrey F
dc.contributor.authorKALLOGJERI, D
dc.contributor.authorBROOKS, Rebecca A
dc.contributor.authorMASSAD, Leslie S
dc.contributor.authorMUTCH, David G
dc.contributor.authorPOWELL, Matthew A
dc.contributor.authorTHAKER, Premal H
dc.contributor.authorMcCOURT, Carolyn K
dc.contributor.departmentObstetrics and Gynecology, School of Medicineen_US
dc.date.accessioned2018-06-08T19:52:49Z
dc.date.available2018-06-08T19:52:49Z
dc.date.issued2016-12
dc.description.abstractBACKGROUND The incidence of endometrial cancer increases with age and is associated with medical comorbidities such as obesity and diabetes. While a few cohort studies of less than 500 patients showed an association between comorbidity and survival in endometrial cancer patients, the degree of association needs to be better described. The Adult Comorbidity Evaluation 27 (ACE-27) is a validated comorbidity instrument that provides a score (0–3) based on the number and severity of medical comorbidities. OBJECTIVE This study was performed to explore the association between medical comorbidities and survival of endometrial cancer patients. STUDY DESIGN Patients diagnosed with endometrial cancer from 2000–2012 were identified from the prospectively maintained Siteman Cancer Center tumor registry. Patients undergoing primary surgical treatment for endometrioid, serous and clear cell endometrial carcinoma were included. Patients primarily treated with radiation, chemotherapy or hormone therapy were excluded. Patients with uterine sarcomas or neuroendocrine tumors were excluded. Patients with missing ACE-27 scores were also excluded from analysis. Information including patient demographics, ACE-27 score, tumor characteristics, adjuvant treatment and survival data were extracted from the database. The association of ACE-27 and overall as well as recurrence-free survival was explored in a multivariable Cox regression analysis after controlling for variables found to be significantly associated with survival in univariable analysis. RESULTS A total of 2073 patients with a median age of 61 years (range 20–94) at diagnosis were identified. ACE-27 score was 0, 1, 2 and 3 in 22%, 38%, 28% and 12% of patients, respectively. Stage distribution was I (73%), II (5%), III (15%) and IV (7%) and grade distribution was 1 (52%), 2 (23%) and 3 (25%). Most patients had endometrioid histology (87%) followed by serous (11%) and clear cell (3%). The median OS for the entire cohort was 54 months [95% confidence interval (CI) 3, 154 months] and median PFS was 50 months [95% CI 2, 154 months]., On univariable analysis, age, race, marital status, stage, grade, histology and treatment type were significantly associated with overall survival and recurrence-free survival. After adjusting for these covariates, patients with ACE-27 score of 2 had a 52% higher risk of death [95% CI 1.16, 2.00] and patients with ACE-27 score of 3 had a 2.35-fold increased risk of death [95% CI 1.73, 3.21] compared to patients with an ACE-27 score of 0. Similarly, patients with ACE-27 score of 2 had a 38% higher risk of recurrence [95% CI 1.07, 1.78] and patients with ACE-27 score of 3 had a 2.05-fold increased risk of recurrence [95% CI 1.53, 2.75] compared to patients with an ACE-27 score of 0. We found no interaction between ACE-27 score and age, stage or treatment type. CONCLUSIONS Our findings demonstrate the importance of comorbidities in estimating the prognosis of endometrial cancer patients, even after adjusting for age and known tumor-specific prognostic factors like stage, grade, histology and adjuvant treatment.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationBINDER, P. S., PEIPERT, J. F., KALLOGJERI, D., BROOKS, R. A., MASSAD, L. S., MUTCH, D. G., … McCOURT, C. K. (2016). Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients. American Journal of Obstetrics and Gynecology, 215(6), 766.e1-766.e9. https://doi.org/10.1016/j.ajog.2016.07.035en_US
dc.identifier.issn0002-9378en_US
dc.identifier.urihttps://hdl.handle.net/1805/16450
dc.language.isoen_USen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.ajog.2016.07.035en_US
dc.relation.journalAmerican journal of obstetrics and gynecologyen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectcomorbidityen_US
dc.subjectendometrial canceren_US
dc.subjectsurvivalen_US
dc.titleAdult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patientsen_US
dc.typeArticleen_US
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