Department of Radiation Oncology Henry Ford Hospital, Detroit, MI 48202, USA.
Gynecol Oncol. 2013 Dec;131(3):593-7. doi: 10.1016/j.ygyno.2013.10.007. Epub 2013 Oct 11.
To determine the impact of Age-Adjusted Charlson Comorbidity (AAC) index score on survival outcomes for patients with early stage endometrial cancer.
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.
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.
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.
确定年龄调整 Charlson 共病（AAC）指数评分对早期子宫内膜癌患者生存结果的影响。
在获得机构审查委员会批准后，通过医生病历回顾，对 671 例 2009 年FIGO Ⅰ-Ⅱ期子宫内膜样腺癌患者的 AAC 评分进行回顾性分析。患者根据 AAC 评分分为以下几组：0-1（n=204）、2-3（n=293）和>3（n=174）。使用 Kaplan-Meier 和对数秩检验方法以及单变量和多变量 Cox 回归分析模型，确定每个生存终点的显著预测因素。
中位随访 85 个月后，记录了 225 例死亡（34 例死于 EC，191 例死于其他原因），7 年总生存率（OS）和疾病特异性生存率（DSS）分别为 77.6%和 94.0%。根据 AAC 分组，7 年 OS、DSS 和无复发生存率（RFS）分别为：AAC 0-1 组为 92.9%、96.8%和 94.9%；AAC 2-3 组为 81.7%、95.3%和 89.8%；AAC>3 组为 56%、88.2%和 84.9%（p<0.0001，p=0.005 和 p=0.013）。多变量分析显示，较高的 AAC 评分、肿瘤分级、子宫下段受累和脉管侵犯是 OS 较短的独立预测因素，而 DSS 和 RFS 中，肿瘤分级和脉管侵犯是较差预后的独立预测因素，但较高的 AAC 评分不是。
共病评分与病理特征一样，对预测早期子宫内膜样腺癌患者的总体生存结果至关重要。较高的 AAC 评分准确预测了 OS 更差的结果。共病评分应在子宫内膜癌的前瞻性临床试验中考虑。
