title: Comorbidity is a prognostic factor in elderly patients with head and neck cancer.
abstract: BACKGROUND
  The number of aged patients with head and neck cancer is increasing. Comorbidities are common in this population. It is necessary to evaluate the effect of comorbidities as measured with the ACE-27 index on recurrence and survival of elderly patients with head and neck cancer, adjusting by other prognostic factors as age, clinical stage and functional status index.
  
  
  METHODS
  Three hundred and ten patients greater than 70 years of age with head and neck cancer in a referral cancer center were studied. Comorbidity measured with the ACE-27 index was the main independent variable. The outcomes were recurrence and survival.
  
  
  RESULTS
  Comorbidities were present in 75% of patients. Five-year disease-free survival, overall survival and cancer-specific survival were 63.1, 42.8 and 55.8%, respectively. Advanced clinical stage and Karnofsky index < or =70 were associated with recurrence. Age >80 years, male gender, Karnofsky index < or =80, advanced clinical stage, and ACE value > or =2 were independently associated with overall survival. The ACE-27 value was not associated with cancer-specific survival. The Karnofsky performance index was associated with overall survival and mortality and acted as a confounding factor on multivariable analysis on overall and cancer-specific survival.
  
  
  CONCLUSIONS
  Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer.
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaringology, Hospital do Câncer AC Camargo, Fundação Antonio Prudente, São Paulo, Brazil. alvarosanabria@gmail.com
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanabria
authors.forename: André Lopes
authors.initials: AL
authors.lastname: Carvalho
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Vartanian
authors.forename: José
authors.initials: J
authors.lastname: Magrin
authors.forename: Mauro Kasuo
authors.initials: MK
authors.lastname: Ikeda
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004066:Digestive System Diseases / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome