Rui Guo1, Xiao-Zhong Chen2, Lei Chen1, Feng Jiang2, Ling-Long Tang1, Yan-Ping Mao1, Guan-Qun Zhou1, Wen-Fei Li1, Li-Zhi Liu3, Li Tian3, Ai-Hua Lin4, Jun Ma5. 1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China. 2. Department of Radiation Oncology, Zhejiang Cancer Hospital, People's Republic of China. 3. Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China. 4. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, People's Republic of China. 5. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China. Electronic address: majun2@mail.sysu.edu.cn.
Abstract
BACKGROUND AND PURPOSE: The impact of comorbidity on prognosis in nasopharyngeal carcinoma (NPC) is poorly characterized. MATERIAL AND METHODS: Using the Adult Comorbidity Evaluation-27 (ACE-27) system, we assessed the prognostic value of comorbidity and developed, validated and confirmed a predictive score model in a training set (n=658), internal validation set (n=658) and independent set (n=652) using area under the receiver operating curve analysis. RESULTS: Comorbidity was present in 40.4% of 1968 patients (mild, 30.1%; moderate, 9.1%; severe, 1.2%). Compared to an ACE-27 score ⩽1, patients with an ACE-27 score >1 in the training set had shorter overall survival (OS) and disease-free survival (DFS) (both P<0.001), similar results were obtained in the other sets (P<0.05). In multivariate analysis, ACE-27 score was a significant independent prognostic factor for OS and DFS. The combined risk score model including ACE-27 had superior prognostic value to TNM stage alone in the internal validation set (0.70 vs. 0.66; P=0.02), independent set (0.73 vs. 0.67; P=0.002) and all patients (0.71 vs. 0.67; P<0.001). CONCLUSIONS: Comorbidity significantly affects prognosis, especially in stages II and III, and should be incorporated into the TNM staging system for NPC. Assessment of comorbidity may improve outcome prediction and help tailor individualized treatment.
BACKGROUND AND PURPOSE: The impact of comorbidity on prognosis in nasopharyngeal carcinoma (NPC) is poorly characterized. MATERIAL AND METHODS: Using the Adult Comorbidity Evaluation-27 (ACE-27) system, we assessed the prognostic value of comorbidity and developed, validated and confirmed a predictive score model in a training set (n=658), internal validation set (n=658) and independent set (n=652) using area under the receiver operating curve analysis. RESULTS: Comorbidity was present in 40.4% of 1968 patients (mild, 30.1%; moderate, 9.1%; severe, 1.2%). Compared to an ACE-27 score ⩽1, patients with an ACE-27 score >1 in the training set had shorter overall survival (OS) and disease-free survival (DFS) (both P<0.001), similar results were obtained in the other sets (P<0.05). In multivariate analysis, ACE-27 score was a significant independent prognostic factor for OS and DFS. The combined risk score model including ACE-27 had superior prognostic value to TNM stage alone in the internal validation set (0.70 vs. 0.66; P=0.02), independent set (0.73 vs. 0.67; P=0.002) and all patients (0.71 vs. 0.67; P<0.001). CONCLUSIONS: Comorbidity significantly affects prognosis, especially in stages II and III, and should be incorporated into the TNM staging system for NPC. Assessment of comorbidity may improve outcome prediction and help tailor individualized treatment.
Authors: Ying Huang; Wei Chen; Waqar Haque; Vivek Verma; Yan Xing; Bin S Teh; Edward Brian Butler Journal: Cancer Med Date: 2018-03-01 Impact factor: 4.452