title: Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model.
abstract: OBJECTIVE
  Patients with cancer often experience comorbidities that may affect their prognosis and outcome. The objective of this study was to determine the effect of comorbidities on the survival of patients with myelodysplastic syndrome (MDS).
  
  
  METHODS
  We conducted a retrospective cohort study of 600 consecutive patients with MDS who presented to MD Anderson Cancer Center from January 2002 to December 2004. The Adult Comorbidity Evaluation-27 (ACE-27) scale was used to assess comorbidities. Data on demographics, International Prognostic Scoring System (IPSS), treatment, and outcome (leukemic transformation and survival) were collected. Kaplan-Meier methods and Cox regression were used to assess survival. A prognostic model incorporating baseline comorbidities with age and IPSS was developed to predict survival.
  
  
  RESULTS
  Overall median survival was 18.6 months. According to the ACE-27 categories, median survival was 31.8, 16.8, 15.2, and 9.7 months for those with none, mild, moderate, and severe comorbidities, respectively (P < .001). Adjusted hazard ratios were 1.3, 1.6, and 2.3 for mild, moderate, and severe comorbidities, respectively, compared with no comorbidities (P < .001). A final prognostic model including age, IPSS, and comorbidity score predicted median survival of 43.0, 23.0, and 9.0 months for lower-, intermediate-, and high-risk groups, respectively (P < .001).
  
  
  CONCLUSIONS
  Comorbidities have a significant impact on the survival of patients with MDS. Patients with severe comorbidity had a 50% decrease in survival, independent of age and IPSS risk group. A comprehensive assessment of the severity of comorbidities helps predict survival in patients with MDS.
authors.affiliation: The University of Texas MD Anderson Cancer, Houston, TX 77030, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Naqvi
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.forename: Sagar
authors.initials: S
authors.lastname: Sardesai
authors.forename: Jeong
authors.initials: J
authors.lastname: Oh
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Vigil
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.forename: Jianqin
authors.initials: J
authors.lastname: Shan
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult