L’indice de comorbidité de Charlson ajusté selon l’âge est un outil pronostique précieux dans le sarcome des tissus mous opérable du tronc et des extrémités

Abstract

BackgroundAdvanced age and presence of comorbidities affect prognosis and treatment decisions in patients with soft tissue sarcoma (STS). However, coeffect of age and comorbidities is still unknown. We aimed to investigate prognostic value of age-adjusted Charlson Comorbidity Index (ACCI) in trunk and extremity STS operated with curative intent. HypothesisPreoperative ACCI might predict survival outcomes independently in patients with STS of trunk and extremities. Patients and methodsThe study included 151 patients and ACCI was calculated for each patient. We categorized the patients into two groups according to median ACCI. We retrospectively collected data about clinicopathologic and treatment-related factors, and evaluated potential prognostic factors for disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. ResultsMedian age was 50 (18–86) years. There were 89 male and 62 female patients. Lower extremities were the most common tumor sites (73.5 %). Most of the patients had high grade tumors (84.1 %) and stage 3 disease (66.9 %). Radiotherapy and chemotherapy were carried out in 106 and 58 patients, respectively. Overall prevalence of comorbidity was 29.1 %. Median ACCI was 3 (2–9). Older age (p<0.001), worse performance status (p<0.001), larger tumor size (p=0.03), higher grade tumors (p=0.03) and advanced stage (p=0.04) were associated with higher ACCI (≥3). Median follow-up time was 32 months, 50.3 % of patients had disease recurrence, and 35.8 % died. Median DFS (p=0.001) and OS (p=0.001) of patients with low ACCI (<3) were significantly longer than patients with high ACCI. Multivariate analysis determined ACCI as an independent prognostic indicator for both DFS (HR 1.72, p=0.02) and OS (HR 2.02, p=0.04). DiscussionACCI is a valuable prognostic tool to be used in the preoperative setting of patients with STS. Higher ACCI was found to be independently associated with worse survival outcomes. For each patient with STS, evaluating comorbidities and combining them with age appears to be a critical step in modifying therapy options. Level of evidenceIV, retrospective observational study.