Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3692–3699 | Cite as

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

  • 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
  • Beyhan Ataseven
Gynecologic Oncology

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.

Notes

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.

Supplementary material

10434_2017_6079_MOESM1_ESM.docx (66 kb)
Supplementary material 1 (DOCX 66 kb)

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Annett Kahl
    • 1
  • Andreas du Bois
    • 1
  • Philipp Harter
    • 1
  • Sonia Prader
    • 1
  • Stephanie Schneider
    • 1
  • Florian Heitz
    • 1
  • Alexander Traut
    • 1
  • Pier Francesco Alesina
    • 2
  • Beate Meier
    • 2
  • Martin Walz
    • 2
  • Annettte Brueckner
    • 3
  • Harald-Thomas Groeben
    • 3
  • Violeta Brunkhorst
    • 3
  • Sebastian Heikaus
    • 4
  • Beyhan Ataseven
    • 1
  1. 1.Department of Gynecology and Gynecologic OncologyKliniken Essen-Mitte, Evangelische Huyssens-StiftungEssenGermany
  2. 2.Department of Visceral SurgeryKliniken Essen-MitteEssenGermany
  3. 3.Center for PathologyKliniken Essen-MitteEssenGermany
  4. 4.Department of Anesthesiology and Intensive CareKliniken Essen-MitteEssenGermany

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