title: Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer.
abstract: OBJECTIVE
  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 AAC grouping, the 7-year OS, DSS, and Recurrence-free survival (RFS) were: 92.9%, 96.8%, and 94.9% for AAC 0-1; 81.7%, 95.3%, and 89.8% for AAC 2-3: and 56%, 88.2%, and 84.9% for AAC>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 AAC 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 AAC scores accurately predicted for worse OS. Comorbidity score should be considered in prospective clinical trials of endometrial carcinoma.
authors.affiliation: Department of Radiation Oncology Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Robbins
authors.forename: Omar H
authors.initials: OH
authors.lastname: Gayar
authors.forename: Mark
authors.initials: M
authors.lastname: Zaki
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.forename: Thomas
authors.initials: T
authors.lastname: Buekers
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
keywords: Age-adjusted Charlson; Comorbidity; Endometrial; Uterine