J Gynecol Oncol.  2019 Jan;30(1):e6. 10.3802/jgo.2019.30.e6.

The age-adjusted Charlson comorbidity index as a predictor of survival in surgically treated vulvar cancer patients

• Di Donato
• Page Z
• Bracchi C
• Tomao F
• Musella A
• Perniola G
• Panici PB

• KMID: 2429575
• DOI: http://doi.org/10.3802/jgo.2019.30.e6

Abstract

OBJECTIVE
To evaluate the impact of age-adjusted Charlson comorbidity index (ACCI) in predicting disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) among surgically treated patients with vulvar carcinoma. The secondary aim is to evaluate its impact as a predictor of the pattern of recurrence.
METHODS
We retrospectively evaluated data of patients that underwent surgical treatment for vulvar cancer from 1998 to 2016. ACCI at the time of primary surgery was evaluated and patients were classified as low (ACCI 0-1), intermediate (ACCI 2-3), and high risk (>3). DFS, OS and CSS were analyzed using the Kaplan-Meir and the Cox proportional hazard models. Logistic regression model was used to assess predictors of distant and local recurrence.
RESULTS
Seventy-eight patients were included in the study. Twelve were classified as low, 36 as intermediate, and 30 as high risk according to their ACCI. Using multivariate analysis, ACCI class was an independent predictor of worse DFS (hazard ratio [HR]=3.04; 95% confidence interval [CI]=1.54-5.99; p < 0.001), OS (HR=5.25; 95% CI=1.63-16.89; p=0.005) and CSS (HR=3.79; 95% CI=1.13-12.78; p=0.03). Positive nodal status (odds ratio=8.46; 95% CI=2.13-33.58; p=0.002) was the only parameter correlated with distant recurrence at logistic regression.
CONCLUSION
ACCI could be a useful tool in predicting prognosis in surgically treated vulvar cancer patients. Prospective multicenter trials assessing the role of ACCI in vulvar cancer patients are warranted.

Keyword

Vulvar Cancer; Comorbidity; Prognostic Factors; Elderly; Frailty

MeSH Terms

Aged
Comorbidity*
Disease-Free Survival
Humans
Logistic Models
Multicenter Studies as Topic
Multivariate Analysis
Prognosis
Proportional Hazards Models
Prospective Studies
Recurrence
Retrospective Studies
Vulvar Neoplasms*