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Prognostic Value of the Age-Adjusted Charlson Comorbidity Index (ACCI) on Short- and Long-Term Outcome in Patients with Advanced Primary Epithelial Ovarian Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Patients and Methods

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.

Results

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.

Conclusion

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.

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Disclosures

Annett Kahl, Andreas du Bois, Philipp Harter, Sonia Prader, Stephanie Schneider, Florian Heitz, Alexander Traut, Pier Francesco Alesina, Beate Meier, Martin Walz, Annettte Brueckner, Harald-Thomas Groeben, Violeta Brunkhorst, Sebastian Heikaus, and Beyhan Ataseven declare no conflicts of interest with respect to the topic of this work.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany

    Annett Kahl MD, Andreas du Bois MD, PhD, Philipp Harter MD, PhD, Sonia Prader MD, Stephanie Schneider MD, Florian Heitz MD, Alexander Traut MD & Beyhan Ataseven MD, PhD

  2. Department of Visceral Surgery, Kliniken Essen-Mitte, Essen, Germany

    Pier Francesco Alesina MD, Beate Meier MD & Martin Walz MD, PhD

  3. Center for Pathology, Kliniken Essen-Mitte, Essen, Germany

    Annettte Brueckner MD, Harald-Thomas Groeben MD, PhD & Violeta Brunkhorst MD

  4. Department of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany

    Sebastian Heikaus MD, PhD

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  1. Annett Kahl MD
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Corresponding author

Correspondence to Beyhan Ataseven MD, PhD.

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Kahl, A., du Bois, A., Harter, P. et al. Prognostic Value of the Age-Adjusted Charlson Comorbidity Index (ACCI) on Short- and Long-Term Outcome in Patients with Advanced Primary Epithelial Ovarian Cancer. Ann Surg Oncol 24, 3692–3699 (2017). https://doi.org/10.1245/s10434-017-6079-9

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