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American Society of Anesthesiologists physical status score as a predictor of long-term outcome in women with endometrial cancer
  1. Anne Maarit Kolehmainen1,
  2. Annukka Pasanen2,
  3. Taru Tuomi3,
  4. Riitta Koivisto-Korander3,
  5. Ralf Butzow4 and
  6. Mikko Loukovaara3
  1. 1Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
  2. 2University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  3. 3Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
  4. 4HUSLAB; Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Dr Anne Maarit Kolehmainen, Obstetrics and Gynecology, Naistenklinikka, Helsinki 00290, Finland; anne.a.kolehmainen{at}


Objective To study the association of the American Society of Anesthesiologists (ASA) physical status score with long-term outcome in endometrial cancer.

Methods Overall, disease-specific and non-cancer-related survival were estimated using simple and multivariable Cox regression analyses and the Kaplan-Meier method.

Results A total of 1166 patients were included in the study. Median follow-up time was 76 (range 1–136) months. All-cause and non-cancer-related mortality were increased in patients whose ASA physical status score was III (HRs 2.5 and 8.0, respectively) or IV (HRs 5.7 and 25, respectively), and cancer-related mortality was increased in patients whose score was IV (HR 2.7). Kaplan-Meier analyses demonstrated a worse overall, disease-specific and non-cancer-related survival for patients whose score was ≥III (p<0.0001 for all). Disease-specific survival was also separately analyzed for patients with stage I and stage II–IV cancer. Compared with patients whose score was ≤II, the survival was worse for patients whose score was ≥III in both subgroups of stages (p=0.003 and p=0.017 for stage I and stages II–IV, respectively). ASA physical status score remained an independent predictor of all-cause mortality (HR 2.2 for scores ≥III), cancer-related mortality (HRs 1.7 and 2.2 for scores ≥III and IV, respectively) and non-cancer related mortality (HR 3.1 for scores ≥III) after adjustment for prognostically relevant clinicopathologic and blood-based covariates. ASA physical status score also remained an independent predictor of cancer-related mortality after exclusion of patients who were at risk for nodal involvement based on features of the primary tumor but who did not undergo lymphadenectomy, and patients with advanced disease who received suboptimal chemotherapy (HRs 1.6 and 2.5 for scores ≥III and IV, respectively).

Conclusions ASA physical status score independently predicts overall survival, disease-specific survival, and non-cancer-related survival in endometrial cancer.

  • American Society of Anesthesiologists
  • endometrial cancer
  • physical status score

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  • Correction notice This article has been corrected since it was published online first. The last two authors in the author list were previously transposed.

  • Contributors AK, AP, TT, RK-K, RB and ML contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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