Predictive value of three comorbidity indices for survival endpoints in oral squamous cell carcinoma

The negative impact of comorbidities on oral cancer prognosis is well known. Few validated comorbidity indices are currently available for clinical management. This study aimed to determine the most relevant index among the Charlson Comorbidity Index (CCI), Age-Adjusted CCI (ACCI), and Adult Comorbidity Evaluation 27 (ACE-27) in terms of survival endpoints in oral cancer.

This retrospective study investigated the impact of comorbidities and other factors on the prognosis of 674 patients with oral squamous cell carcinoma (OSCC). Comorbidities were assessed in each patient using the CCI, ACCI, and ACE-27. Univariate and multivariate models were used to identify the predictors of survival.

Compared to ACE-27 and CCI, severe ACCI was the only meaningful predictor of OSCC (adjusted hazard ratio [AHR] for disease-free survival [DFS]: 1.822, 95 % confidence interval [CI]: 1.237-2.684, P = 0.002; AHR for overall survival [OS]: 2.681, 95 % CI: 1.638-4.389, P < 0.001). More importantly, the ACCI demonstrated excellent prognostic stratification in patients with OSCC undergoing surgery and adjuvant therapy (AHRs for DFS: moderate, 1.692, 95 % CI: 1.013-2.826, P = 0.044; severe, 2.545, 95 % CI: 1.283-5.049, P = 0.008; AHRs for OS: moderate, 2.004, 95 % CI: 1.078-3.725, P = 0.028; severe, 3.086, 95 % CI: 1.397-6.817, P = 0.005).

The ACCI is an essential predictor of OSCC prognosis. We suggest that the ACCI be included in the routine clinical evaluation system, especially to evaluate the comorbidity and prognosis of patients with OSCC undergoing surgery combined with adjuvant therapy.