title: Predictive Capacity of 3 Comorbidity Indices in Estimating Survival Endpoints in Women With Early-Stage Endometrial Carcinoma.
abstract: The negative impact of comorbidity on survival in women with endometrial carcinoma (EC) is well-known. Few validated comorbidity indices are available for clinical use, such as the Charlson Comorbidity Index (CCI), the Age-Adjusted CCI (AACCI), and the Adult Comorbidity Evaluation-27 (ACE-27). The aim of the study is to determine which index best correlates with survival endpoints in women with EC.
  
  
  
  We identified 1132 women with early-stage EC treated at an academic center. Three scores were calculated for each patient using CCI, AACCI, and ACE-27 at the time of hysterectomy. Univariate and multivariable modeling was used to determine predictors of survival.
  
  
  
  For each of the studied comorbidity indices, the highest scores were significantly correlated with poorer overall survival. The hazard ratio of death from any cause was 3.92 for AACCI, 2.25 for CCI, and 1.57 for ACE-27. All 3 indices were independent predictors of overall survival with a P value of less than 0.001 on multivariate analysis. In addition, lymphovascular space invasion, lower uterine segment involvement, and tumor grade were predictors of overall survival. Lymphovascular space invasion, grade (P < 0.001), and high AACCI score were the only significant predictors of recurrence-free survival (RFS). Lymphovascular space invasion and tumor grade were the only 2 predictors of disease-specific survival.
  
  
  
  Although all 3 studied comorbidity indices were significant predictors of overall survival in women with early-stage EC, AACCI showed a stronger association. It should be considered for evaluating comorbidity in women with early-stage EC.
authors.affiliation: *Department of Radiation Oncology, Henry Ford Hospital; †Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital; and ‡Department of Public Health Science, Henry Ford Hospital, Detroit, MI.
authors.forename: Karine A
authors.initials: KA
authors.lastname: Al Feghali
authors.forename: Jared R
authors.initials: JR
authors.lastname: Robbins
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.forename: Charlotte
authors.initials: C
authors.lastname: Burmeister
authors.forename: Nadia T
authors.initials: NT
authors.lastname: Khan
authors.forename: Nabila
authors.initials: N
authors.lastname: Rasool
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
mesh_terms: D000328:Adult; 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; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index