Predictive value of the age-adjusted Charlson comorbidity index on perioperative complications and survival in patients undergoing surgery for advanced ovarian cancer

Abstract

Objectives: To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer. Methods: Data were analyzed for all patients with stages IIIB–IV ovarian, fallopian tube, and primary peritoneal cancer who underwent primary cytoreduction at our institution from 1/2001 to 1/2010. The ACCI is a validated predictor of 1-year mortality and is based on age and the weighted scores of 19 medical comorbidities. Perioperative complications at up to 30 days postoperatively were graded for severity using a standardized institutional grading system. Patientswere divided into three groups based on an ACCI of 0–1, 2–3, and ≥4. Clinical and survival outcomes were assessed and compared for the three groups. Appropriate statistical tests were used. Results: A total of 567 patients met inclusion criteria, of whom 200 (35%) had an ACCI of 0–1, 272 (48%) had an ACCI of 2–3, and 95 (17%) had an ACCI of ≥4. The most common comorbidities were chronic pulmonary disease (n= 55, 10%), connective tissue disease (n= 37, 7%), other solid tumors (n= 32, 6%), and diabetes mellitus (n= 26, 5%). The ACCI was significantly associated with the rate of complete gross resection (0–1 = 44%, 2–3 = 31%, and ≥4 = 33%, P= 0.01) but was not associated with the rate of minor (47% vs. 47% vs. 43%, P= 0.82) or major (19% vs. 18% vs. 16%, P=0.83) complications. The ACCI was also significantly associated with progression-free (PFS) and overall survival (OS). Median PFS for patients who had an ACCI of 0–1, 2–3, and ≥4 was 20.3 months, 16 months, and 15.6 months, respectively (P=0.03). Median OS for patients who had an ACCI of 0–1, 2–3, and ≥4 was 65.3 months, 49.9 months, and 42.3 months, respectively (P b 0.001). Onmultivariate analysis, after adjusting for stage, histology, preoperative albumin, ascites volume, residual disease, and intraperitoneal chemotherapy administration, both PFS (P= 0.02) and OS (P b 0.001) remained significant. Conclusions: The ACCI was a significant predictor of PFS and OS in patients undergoing primary cytoreduction for advanced epithelial ovarian cancer. Prospective clinical trials in ovarian cancer should consider stratifying for comorbidity.