Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany.
Department of Visceral Surgery, Kliniken Essen-Mitte, Essen, Germany.
Ann Surg Oncol. 2017 Nov;24(12):3692-3699. doi: 10.1245/s10434-017-6079-9. Epub 2017 Sep 5.
We evaluated the prognostic impact of the age-adjusted Charlson Comorbidity Index (ACCI) on both postoperative morbidity and overall survival (OS) in patients with advanced epithelial ovarian cancer (EOC) treated at a tertiary gynecologic cancer center.
Exploratory analysis of our prospectively documented tumor registry was performed. Data of all consecutive patients with stage IIIB-IV ovarian cancer who underwent primary cytoreductive surgery (PDS) from January 2000 to June 2016 were analyzed. Patients were divided into three groups, based on their ACCI: low (0-1), intermediate (2-3), and high (≥4), and postoperative surgical complications were graded according to the Clavien-Dindo classification (CDC). The Fisher's exact test, log-rank test, and Cox regression models were used to investigate the predictive value of the ACCI on postoperative complications and OS.
Overall, 793 consecutive patients were identified; 328 (41.4%) patients were categorized as low ACCI, 342 (43.1%) as intermediate ACCI, and 123 (15.5%) as high ACCI. A high ACCI was significantly associated with severe postoperative complications (CDC 3-5; odds ratio 3.27, 95% confidence interval 1.97-5.43, p < 0.001). Median OS for patients with a low, intermediate, or high ACCI was 50, 40, and 23 months, respectively (p < 0.001), and the ACCI remained a significant prognostic factor for OS in multivariate analysis (p = 0.001). The same impact was observed in a sensitivity analysis including only those patients with complete tumor resection.
The ACCI is associated with perioperative morbidity in patients undergoing PDS for EOC, and also has a prognostic impact on OS. The potential role of the ACCI as a selection criteria for different therapy strategies is currently under investigation in the ongoing, prospective, multicenter AGO-OVAR 19 trial.
我们评估了年龄调整 Charlson 合并症指数（ACCI）对在三级妇科癌症中心接受治疗的晚期上皮性卵巢癌（EOC）患者术后发病率和总生存（OS）的预后影响。
对我们前瞻性记录的肿瘤登记处进行了探索性分析。分析了 2000 年 1 月至 2016 年 6 月期间接受初次细胞减灭术（PDS）的所有连续 IIIB-IV 期卵巢癌患者的数据。根据他们的 ACCI 将患者分为三组：低（0-1）、中（2-3）和高（≥4），并根据 Clavien-Dindo 分类（CDC）对术后手术并发症进行分级。使用 Fisher 确切检验、对数秩检验和 Cox 回归模型来研究 ACCI 对术后并发症和 OS 的预测价值。
共确定了 793 例连续患者；328 例（41.4%）患者被归类为低 ACCI，342 例（43.1%）为中 ACCI，123 例（15.5%）为高 ACCI。高 ACCI 与严重术后并发症显著相关（CDC 3-5；优势比 3.27，95%置信区间 1.97-5.43，p<0.001）。低、中、高 ACCI 患者的中位 OS 分别为 50、40 和 23 个月（p<0.001），在多变量分析中 ACCI 仍然是 OS 的显著预后因素（p=0.001）。在仅包括完全肿瘤切除患者的敏感性分析中也观察到了相同的影响。
ACCI 与接受 EOC PDS 的患者围手术期发病率相关，并且对 OS 也具有预后影响。ACCI 作为不同治疗策略选择标准的潜在作用目前正在正在进行的、前瞻性的、多中心 AGO-OVAR 19 试验中进行研究。
