Article Text

Download PDFPDF
Predictive Capacity of 3 Comorbidity Indices in Estimating Survival Endpoints in Women With Early-Stage Endometrial Carcinoma
  1. Karine A. Al Feghali, MD,
  2. Jared R. Robbins, MD,
  3. Meredith Mahan, MS,
  4. Charlotte Burmeister, MS,
  5. Nadia T. Khan, BS,
  6. Nabila Rasool, MD,
  7. Adnan Munkarah, MD and
  8. Mohamed A. Elshaikh, MD
  1. * Department of Radiation Oncology, Henry Ford Hospital;
  2. Division of Gynecologic Oncology, Department of Women’s Health Services, Henry Ford Hospital; and
  3. Department of Public Health Science, Henry Ford Hospital, Detroit, MI.
  1. Address correspondence and reprint requests to Mohamed A. Elshaikh, MD, Department of Radiation Oncology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202. E-mail: melshai1{at}


Objective The negative impact of comorbidity on survival in women with endometrial carcinoma (EC) is well-known. Few validated comorbidity indices are available for clinical use, such as the Charlson Comorbidity Index (CCI), the Age-Adjusted CCI (AACCI), and the Adult Comorbidity Evaluation-27 (ACE-27). The aim of the study is to determine which index best correlates with survival endpoints in women with EC.

Materials and Methods We identified 1132 women with early-stage EC treated at an academic center. Three scores were calculated for each patient using CCI, AACCI, and ACE-27 at the time of hysterectomy. Univariate and multivariable modeling was used to determine predictors of survival.

Results For each of the studied comorbidity indices, the highest scores were significantly correlated with poorer overall survival. The hazard ratio of death from any cause was 3.92 for AACCI, 2.25 for CCI, and 1.57 for ACE-27. All 3 indices were independent predictors of overall survival with a P value of less than 0.001 on multivariate analysis. In addition, lymphovascular space invasion, lower uterine segment involvement, and tumor grade were predictors of overall survival. Lymphovascular space invasion, grade (P < 0.001), and high AACCI score were the only significant predictors of recurrence-free survival (RFS). Lymphovascular space invasion and tumor grade were the only 2 predictors of disease-specific survival.

Conclusions Although all 3 studied comorbidity indices were significant predictors of overall survival in women with early-stage EC, AACCI showed a stronger association. It should be considered for evaluating comorbidity in women with early-stage EC.

  • Endometrial cancer
  • Comorbidity
  • Charlson Comorbidity Index
  • ACE-27
  • Prognosis
  • Age-adjusted
  • Survival

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflicts of interest.