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Original research
Secondary validation of an ovarian cancer-specific comorbidity index in a US population
  1. Chelsey Vranes1,
  2. Hui Zhao2,
  3. Mette Calundann Noer3,
  4. Shuangshuang Fu2,
  5. Charlotte C Sun4,
  6. Ross Harrison4,
  7. Pedro T Ramirez4,
  8. Claus Kim Høgdall3,
  9. Sharon H Giordano2 and
  10. Larissa A Meyer4
  1. 1 Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
  2. 2 Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  4. 4 Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Larissa A Meyer, Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center Division of Surgery, Houston, TX 77030, USA; lmeyer{at}mdanderson.org

Abstract

Objectives The Ovarian Cancer Comorbidity Index (OCCI) is an age-specific index developed and previously found to be more predictive of overall and cancer-specific survival than the Charlson Comorbidity Index (CCI). The objective was to perform secondary validation of the OCCI in a US population.

Methods A cohort of ovarian cancer patients undergoing primary or interval cytoreductive surgery from January 2005 to January 2012 was identified in SEER-Medicare. OCCI scores were calculated with the regression coefficients determined from the original developmental cohort for five comorbidities. Cox regression analyses were used to calculate associations between the OCCI risk groups and 5-year overall survival and 5-year cancer-specific survival in comparison to the CCI.

Results A total of 5052 patients were included. Median age was 74 (range 66–82) years. 47% (n=2375) had stage III and 24% (n=1197) had stage IV disease at diagnosis. 67% had a serous histology subtype (n=3403). All patients were categorized as moderate (48.4%) or high risk (51.6%). The prevalence of the five predictive comorbidities were: coronary artery disease 3.7%, hypertension 67.5%, chronic obstructive pulmonary disease 16.7%, diabetes 21.8%, and dementia 1.2%. Controlling for histology, grade, and age-stratification, worse overall survival was associated with both a higher OCCI (hazard ratio (HR) 1.57; 95% confidence interval (CI) 1.46 to 1.69) and CCI (HR 1.96; 95% CI 1.66 to 2.32). Cancer-specific survival was associated with the OCCI (HR 1.33; 95% CI 1.22 to 1.44) but was not associated with the CCI (HR 1.15; 95% CI 0.93 to 1.43).

Conclusions This internationally developed comorbidity score for ovarian cancer patients is predictive for both overall and cancer-specific survival in a US population. CCI was not predictive for cancer-specific survival. This score may have research applications when utilizing large administrative datasets.

  • Ovarian Cancer

Data availability statement

No data are available. The data may be independently obtained through SEER. We are not authorized to share under data sharing agreement.

https://doi.org/10.1136/ijgc-2022-004100

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    Data availability statement

    No data are available. The data may be independently obtained through SEER. We are not authorized to share under data sharing agreement.

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    Footnotes

    • Twitter @huizhao_liu@yahoo.com, @rossfh

    • Contributors All authors provided the following: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. (2) Drafting the work or revising it critically for important intellectual content. (3) Final approval of the version to be published. (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LAM is the guarantor and accepts full responsibility for the work and/or conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work was supported in part by the MD Anderson Cancer Center Support Grant from the National Cancer Institute of the National Institutes of Health (NIH/NCI P30 CA016672, CA217685) and the T32 training grant CA101642 (SH). LAM is supported by a NIH-NCIK07-CA201013 grant. SHG is supported by CPRIT RP160674 and Komen SAC150061.

    • Competing interests There are no relevant conflicts. However, LAM reports research funding from AstraZeneca, consulting for Glaxo-Smith-Kline, and stocks in Crispr, Invitae, Denali, and Bristol-Myers Squibb. CCS also reports funding from AstraZeneca. The remaining authors report no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.