Comparison between adult comorbidity evaluation-27 and Charlson Comorbidity Index in head and neck oncology

To determine whether Adult Comorbidity Evaluation-27 (ACE-27) or Charlson Comorbidity Index (CCI) is more accurate in predicting overall survival in head and neck squamous cell cancer (HNSCC) patients.

A retrospective study was conducted on all patients with a primary HNSCC diagnosis and treatment between January 1st, 2010, and December 31th, 2013 at ErasmusMC, the Netherlands. Medical records were reviewed for patient data. The following covariables were considered: sex, age, subsite of the index HNSCC, treatment, TNM-stage, tobacco use and alcohol use. Significant covariables were identified with Kaplan-Meier analyses. Two Cox-regression models were made including the covariables and each comorbidity model. The primary endpoint was the c-statistic, with overall survival as the dependent variable and the covariables as the independent variables in the comorbidity models.

A total of 1,193 patients were included in the study, with an average age of 63.9 years (SD:10.7). In the Kaplan-Meier analysis, all variables, except sex, demonstrated a significant correlation with 5-year-overall survival. According to the Cox regression analysis, there was a HR of 2.462 (95 %CI:1.630-3.718) for a CCI of ≥ 5. The HR at an ACE-27 score of 3 was 1.969 (95 %CI:1.457-2.660). The model that incorporated the CCI score resulted in an average c-statistic of 0.6783 (range:0.6524-0.6935), while the mean c-statistic for the model with the ACE-27 was 0.6790 (range:0.6364-0.6973).

In individuals diagnosed with HNSCC, both the ACE-27 and CCI serve as independent factors that reflect overall survival. Their predictive capabilities are comparable, allowing for their interchangeable use in both clinical and research contexts.