Validation of the Washington University Head and Neck Comorbidity Index in a cohort of older patients.
OBJECTIVE
To validate the prognostic ability of the Washington University Head and Neck Comorbidity Index (WUHNCI) relative to 5-year survival in a cohort of older patients with head and neck cancer and to compare it with that of the Adult Comorbidity Evaluation 27 (ACE-27).


METHODS
Validation study.


METHODS
Academic research.


METHODS
Three hundred twenty-one patients older than 70 years with head and neck cancer in a tertiary cancer center. Comorbidity was measured using the ACE-27, WUHNCI, and National Cancer Institute (NCI) comorbidity index.


METHODS
Five-year overall survival.


RESULTS
Five-year overall and cancer-specific survival, respectively, were as follows: Using the WUHNCI, 52.2% and 62.9% for a score of 0; 25.1% and 41.7% for a score of 1; 39.3% and 64.9% for a score of 2; and 19.5% and 45.0% for a score of 3 or higher. Using the ACE-27, 54.4% and 61.7% for a score of 0 (no comorbidity); 46.8% and 61.7% for a score of 1 (mild comorbidity); 31.7% and 51.6% for a score of 2 (moderate comorbidity); and 13.8% and 43.7% for a score of 3 (severe comorbidity). The C statistics were 0.641 for the NCI comorbidity index, 0.656 for the ACE-27, and 0.686 for the WUHNCI.


CONCLUSIONS
The WUHNCI did not demonstrate good discriminative power compared with the ACE-27 in a cohort of older patients. To be widely used, instruments developed to measure comorbidities must be reliable in any population. We believe that the ACE-27 is still the best index to assess comorbidities and that it should be used in studies evaluating the prognostic effect of comorbidities.
Department of Surgery, School of Medicine, Universidad de La Sabana, Fundación Abood Shaio, Campus Puente del Comun, Km 21 Autopista Norte, Bogotá Colombia. alvarosanabria@gmail.com
Alvaro
A
Sanabria
André Lopes
AL
Carvalho
José Guilherme
JG
Vartanian
José
J
Magrin
Mauro Kasuo
MK
Ikeda
Luiz Paulo
LP
Kowalski
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000401:mortality*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011379:Prognosis; D016019:Survival Analysis