Di Donato Violante, D'Oria Ottavia, Giannini Andrea, Bogani Giorgio, Fischetti Margherita, Santangelo Giusi, Tomao Federica, Palaia Innocenza, Perniola Giorgia, Muzii Ludovico, Benedetti Panici Pierluigi
Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy.
Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, PhD Course in "Translational Medicine and Oncology, Sapienza University, Rome, Italy.
Gynecol Obstet Invest. 2022;87(3-4):191-199. doi: 10.1159/000525405. Epub 2022 Jul 6.
Comorbidity scores are increasingly used to reduce potential confounding in oncologic research. This is of paramount importance in endometrial cancer (EC) since it is characterized by quite indolent behavior. Here, we aim to evaluate the impact of various comorbidities and concurrent medications used on survival outcomes, adopting the age-adjusted Charlson comorbidity index (A-CCI).
This is an observational study. Charts of 257 EC patients were retrieved.
We retrospectively evaluated data of patients who underwent surgical treatment for EC. A-CCI was calculated by summing the weighted comorbidities and age of each patient. A binomial value was assigned to different comorbidities and different drugs. Oncologic outcomes were evaluated using Cox proportional hazard models adjusted for age.
A-CCI ≥3 correlated with more aggressive tumor features (47.6% vs. 26.8%, p = 0.001), higher risk of recurrence (29.7% vs. 11.6%, p = 0.001), death (20.7% vs. 7.1%, p = 0.002), and death due to disease (16.6% vs. 6.3%, p = 0.012). Considering comorbidities and drugs at parsimonious multivariable analysis model: cardiac disease, liver disease, and proton pump inhibitors (PPIs) use were independent predictors of disease-free survival. Cardiac disease, autoimmune disease, and PPIs use were independent predictors of overall survival. Diabetes was the only independent predictor for cause-specific survival.
The major limitation of the present study is its retrospective nature and the relatively small sample size that limit the possibility to have firm conclusions.
Patients with EC are characterized by a high burden of comorbidities. Comorbidities are associated directly with survival outcomes. Further attention is needed to improve the active management of comorbidities soon after EC treatments. Interventional studies are needed to improve patients' outcomes.
合并症评分在肿瘤学研究中越来越多地用于减少潜在的混杂因素。这在子宫内膜癌（EC）中至关重要，因为其具有相当惰性的行为特征。在此，我们旨在采用年龄调整后的查尔森合并症指数（A-CCI）来评估各种合并症和同时使用的药物对生存结局的影响。
这是一项观察性研究。检索了257例EC患者的病历。
我们回顾性评估了接受EC手术治疗患者的数据。通过将每位患者的加权合并症和年龄相加来计算A-CCI。为不同的合并症和不同的药物赋予一个二项值。使用针对年龄进行调整的Cox比例风险模型评估肿瘤学结局。
A-CCI≥3与更具侵袭性的肿瘤特征相关（47.6%对26.8%，p = 0.001），复发风险更高（29.7%对11.6%，p = 0.001），死亡风险更高（20.7%对7.1%，p = 0.002），以及因病死亡风险更高（16.6%对6.3%，p = 0.012）。在简约多变量分析模型中考虑合并症和药物时：心脏病、肝病和使用质子泵抑制剂（PPI）是无病生存的独立预测因素。心脏病、自身免疫性疾病和使用PPI是总生存的独立预测因素。糖尿病是特定病因生存的唯一独立预测因素。
本研究的主要局限性在于其回顾性性质以及相对较小的样本量，这限制了得出确凿结论的可能性。
EC患者具有较高的合并症负担。合并症与生存结局直接相关。在EC治疗后不久，需要进一步关注以改善合并症的积极管理。需要进行干预性研究以改善患者结局。
