title: Comorbidity as predictor poor prognosis for patients with advanced head and neck cancer treated with major surgery.
abstract: BACKGROUND
  The impact of comorbidities on patients with advanced head and neck cancer treated with major surgery has not been reported before.
  
  
  METHODS
  We retrospectively reviewed clinical charts between 2004 and 2011 at our institution and identified 185 patients with clinical stage III to IV head and neck cancer treated with major surgery. Comorbidities were scored using the Adult Comorbidity Evaluation-27 (ACE-27) index manual.
  
  
  RESULTS
  Patients with ACE-27 ≥2 had significantly worse overall survival (OS) and disease-specific survival (DSS) than those with ACE-27 ≤1 (p < .0001 and p = .0047, respectively). Multivariate analyses revealed that ACE-27 ≥2 and extracapsular spread (ECS) were independently significant adverse prognostic factors for OS and DSS. In addition, patients with ACE-27 ≥2 had a higher incidence of distant metastases (p = .0057).
  
  
  CONCLUSIONS
  The current study suggests that comorbidities may predict poor prognosis and development of distant metastases for patients with advanced head and neck cancer treated with major surgery.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Omura
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Mizuo
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Asakage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate
keywords: Adult Comorbidity Index-27 (ACE-27); advanced head and neck cancer; comorbidity; prognostic factor; radical surgery