Phillips Andrew, Singh Kavita, Pounds Rachel, Sundar Sudha, Kehoe Sean, Nevin James, Elattar Ahmed, Balega Janos
a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK.
J Obstet Gynaecol. 2017 Nov;37(8):1070-1075. doi: 10.1080/01443615.2017.1324413. Epub 2017 Jul 25.
The aim of this study was to determine whether the age-adjusted Charlston co-morbidity index (ACCI) can predict post-operative complications, adjuvant chemotherapy usage and overall survival (OS) in patients with advanced epithelial ovarian cancer (AOC) treated with neoadjuvant chemotherapy (NACT). A review was performed of all cytoreductive surgeries performed between 16/8/07-3/2/14 for AOC at a UK Cancer Centre. All surgeries were stratified by ACCI into three groups: Low (0-1), Intermediate (2-3) and High (≥4). Of the 293 cases the ACCI distribution was: 74 (25.26%) low, 164 (55.97%) intermediate and 55 (18.77%) high. Patients with a high ACCI were less likely to receive adjuvant chemotherapy (p = .023), more likely to receive fewer adjuvant cycles (p = .0057) but no more likely to experience complications. Median OS for patients with a low, intermediate and high ACCI was 44.58 (95%CI 36.98-52.19), 34.65 (95%CI 29.48-39.82) and 33.37 (95%CI 17.47-49.27) months. ACCI was associated with OS (p < .01) confirmed on multivariate analysis (p = .03). The ACCI is, therefore, a marker of survival in these patients and predicts adjuvant chemotherapy usage. Impact statement The Age-Adjusted Charlston Co-morbidity Index has previously been identified as a predictor of survival in both medical and surgical conditions. Recently it has also been validated in patients undergoing primary cytoreductive surgery for advanced ovarian cancer. This study is the first to validate the Age-Adjusted Charlston Co-morbidity Index in patients undergoing cytoreductive surgery following neoadjuvant chemotherapy. Our findings demonstrate that it can be used to not only predict overall survival in women undergoing debulking surgery after neo-adjuvant chemotherapy but also predicts the uptake and commencement of adjuvant chemotherapy. Such findings are important considerations to enable an informed patient choice regarding interval surgery in the more co-morbid patients. More importantly, although the ACCI can be used as a marker of overall survival, even in the most co-morbid of patients there remains a significant survival advantage following surgery to the extent that it should not be contraindicated in this cohort. The ACCI is being increasingly incorporated into various clinical trials as a standard demographic measure and this study validates its inclusion in patients undergoing interval debulking surgery.
本研究的目的是确定年龄校正后的查尔森合并症指数（ACCI）能否预测接受新辅助化疗（NACT）的晚期上皮性卵巢癌（AOC）患者的术后并发症、辅助化疗的使用情况及总生存期（OS）。对英国一家癌症中心在2007年8月16日至2014年2月3日期间为AOC患者进行的所有减瘤手术进行了回顾。所有手术根据ACCI分为三组：低（0 - 1）、中（2 - 3）、高（≥4）。在293例病例中，ACCI分布情况为：低74例（25.26%），中164例（55.97%），高55例（18.77%）。ACCI高的患者接受辅助化疗的可能性较小（p = 0.023），接受辅助化疗周期较少的可能性较大（p = 0.0057），但发生并发症的可能性并不更高。ACCI低、中、高的患者的中位OS分别为44.58（95%CI 36.98 - 52.19）、34.65（95%CI 29.48 - 39.82）和33.37（95%CI 17.47 - 49.27）个月。多因素分析证实ACCI与OS相关（p < 0.01）（p = 0.03）。因此，ACCI是这些患者生存情况的一个指标，并可预测辅助化疗的使用情况。影响声明 年龄校正后的查尔森合并症指数此前已被确定为医疗和外科疾病中生存情况的一个预测指标。最近，它在接受晚期卵巢癌初次减瘤手术的患者中也得到了验证。本研究首次在接受新辅助化疗后进行减瘤手术的患者中验证了年龄校正后的查尔森合并症指数。我们的研究结果表明，它不仅可用于预测新辅助化疗后接受减瘤手术的女性的总生存期，还可预测辅助化疗的接受情况和开始时间。这些发现对于使合并症较多的患者在选择间隔手术时能够做出明智的患者决策具有重要意义。更重要的是，尽管ACCI可作为总生存情况的一个指标，但即使是合并症最严重的患者，手术后仍有显著的生存优势，以至于在这一队列中不应将手术作为禁忌。ACCI正越来越多地作为一项标准人口统计学指标纳入各种临床试验，本研究验证了其在接受间隔减瘤手术的患者中的应用。
