title: Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma.
abstract: BACKGROUND
  The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status (PS) on head and neck squamous cell carcinoma (HNSCC) survival.
  
  
  METHODS
  Six hundred patients with HNSCC were prospectively recruited. Comorbidity and PS were measured using the Charlson Comorbidity Index (CCI) and the Eastern Cooperative Oncology Group (ECOG) Scale. Outcomes were overall survival (OS) and cancer-specific survival (CSS).
  
  
  RESULTS
  A total of 48.3% of the patients had at least 1 comorbidity, and 42.3% had impaired PS at baseline. There was no correlation between CCI and ECOG (Spearman's ρ = 0.033; p = .42). In multivariate analysis, CCI score was significantly associated with OS (p = .01). ECOG was not associated with OS, but seems to act as an effect modifier in the association between comorbidity and OS. CCI and ECOG were not associated with CSS.
  
  
  CONCLUSIONS
  CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC, but a significant association with CSS was not observed.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Wang
authors.affiliation: Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Habbous
authors.affiliation: Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Espin-Garcia
authors.affiliation: Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Duoduo
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Simpson
authors.affiliation: Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Fei-Fei
authors.initials: FF
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dale H
authors.initials: DH
authors.lastname: Brown
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.|Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: comorbidity; head and neck squamous cell carcinoma; performance status; prognostic model; survival outcomes