title: Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: development and validation of a predictive score model.
abstract: OBJECTIVE
  The impact of comorbidity on prognosis in nasopharyngeal carcinoma (NPC) is poorly characterized.
  
  
  METHODS
  Using the Adult Comorbidity Evaluation-27 (ACE-27) system, we assessed the prognostic value of comorbidity and developed, validated and confirmed a predictive score model in a training set (n=658), internal validation set (n=658) and independent set (n=652) using area under the receiver operating curve analysis.
  
  
  RESULTS
  Comorbidity was present in 40.4% of 1968 patients (mild, 30.1%; moderate, 9.1%; severe, 1.2%). Compared to an ACE-27 score ⩽1, patients with an ACE-27 score >1 in the training set had shorter overall survival (OS) and disease-free survival (DFS) (both P<0.001), similar results were obtained in the other sets (P<0.05). In multivariate analysis, ACE-27 score was a significant independent prognostic factor for OS and DFS. The combined risk score model including ACE-27 had superior prognostic value to TNM stage alone in the internal validation set (0.70 vs. 0.66; P=0.02), independent set (0.73 vs. 0.67; P=0.002) and all patients (0.71 vs. 0.67; P<0.001).
  
  
  CONCLUSIONS
  Comorbidity significantly affects prognosis, especially in stages II and III, and should be incorporated into the TNM staging system for NPC. Assessment of comorbidity may improve outcome prediction and help tailor individualized treatment.
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, People's Republic of China.
authors.forename: Xiao-Zhong
authors.initials: XZ
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Ling-Long
authors.initials: LL
authors.lastname: Tang
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Mao
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Guan-Qun
authors.initials: GQ
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Wen-Fei
authors.initials: WF
authors.lastname: Li
authors.affiliation: Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Liu
authors.affiliation: Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Tian
authors.affiliation: Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, People's Republic of China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China. Electronic address: majun2@mail.sysu.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: Comorbidity; Multi-cancer centre; Nasopharyngeal carcinoma; Prognosis; Survival