Charleson and Elixhauser Comorbidity Indices in Predicting Mortality Among Young and Old Cervical Cancer Patients

Cervical cancer is the fourth leading cause of cancer deaths in women, and mortality varies significantly by region, with the highest rate in southeastern US. This study evaluated the association between comorbidity burden and cervical cancer survival and compared the prognostic performance of the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI).

A retrospective cohort study was conducted using electronic medical records of women diagnosed with cervical cancer between 2011 and 2021 at a large academic hospital in southeastern US. CCI and ECI were estimated to assess 5-year overall survival using the Kaplan-Meier methods and multivariable Cox proportional hazard models, stratified by age at diagnosis (young < 50 vs. old ≥ 50 years) and adjusting for baseline demographics. Two-year survival analyses were also conducted. Predictive discrimination of CCI and ECI models was compared using Harrell's C-statistic.

Higher comorbidity burden was associated with increased mortality across age groups. Compared with patients with no comorbidities (CCI = 0), CCI scores of 1-4 and ≥ 5 were associated with higher 5-year mortality among younger women (adjusted hazard ratio [aHR] = 2.35 (1.03-5.35); 2.80 (1.38-5.69), respectively) and older women (aHR = 2.38 (1.26-4.50); 1.43 (0.63-3.27), respectively). ECI scores ≥ 3 were also strongly associated with increased 5-year mortality in both age groups. Both indices demonstrated acceptable and comparable predictive discrimination for 5-year survival in both age groups (C-statistics ranging from 0.74-0.70). Findings were consistent in 2-year survival analyses.

Greater comorbidity burden is independently associated with worse survival among cervical cancer patients; highlighting the importance of comorbidity management in cervical cancer care.