Impact of Comorbid Conditions on Survival in Endometrial Cancer

Nicholas, Zachary P.; Hu, Nan; Ying, Jian; Soisson, Patrick; Dodson, Mark K.; Gaffney, David K.

doi:10.1097/coc.0b013e318277d5f4

Cited by 50 publications

(46 citation statements)

References 2 publications

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“…It should be considered that obesity itself (BMI >35 kg/m 2 ) plays a major confounding role because, in several studies, high BMI was an independent prognostic factor for the development of postoperative lymphedema (11,26,38).…”

Section: Incidencementioning

confidence: 99%

Lower Body Lymphedema in Patients with Gynecologic Cancer

Biglia

Zanfagnin

Daniele

et al. 2017

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Section: Incidencementioning

confidence: 99%

Lower Body Lymphedema in Patients with Gynecologic Cancer

Biglia

Zanfagnin

Daniele

et al. 2017

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“…Black women have a higher prevalence of obesity, diabetes mellitus, and hypertension. 13 Although these conditions have been associated with poorer survival rates, 14 a recent report with the use of Surveillance, Epidemiology, and End Results (SEER) Medicare data illustrated that comorbid conditions do not account fully for the racial disparity that is seen in endometrial cancer survival in a Medicare population. 15 We sought to further evaluate the relationship between comorbid conditions and the racial disparity in endometrial cancer survival among women of all ages at a single institution.…”

mentioning

confidence: 99%

The influence of comorbid conditions on racial disparities in endometrial cancer survival

Ruterbusch¹,

Ali-Fehmi²,

Sealy-Jefferson³

et al. 2014

American Journal of Obstetrics and Gynecology

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OBJECTIVE There are known disparities in endometrial cancer survival with black women who experience a greater risk of death compared with white women. The purpose of this investigation was to evaluate the role of comorbid conditions as modifiers of endometrial cancer survival by race. STUDY DESIGN Two hundred seventy-one black women and 356 white women who had been diagnosed with endometrial cancer from 1990–2005 were identified from a large urban integrated health center. A retrospective chart review was conducted to gather information on comorbid conditions and other known demographic and clinical predictors of survival. RESULTS Black women experienced a higher hazard of death from any cause (hazard ratio [HR] 1.51; 95% confidence interval [CI], 1.22–1.87) and from endometrial cancer (HR, 2.42; 95% CI, 1.63–3.60,). After adjustment for known clinical prognostic factors and comorbid conditions, the hazard of death for black women was elevated but no longer statistically significant for overall survival (HR, 1.22; 95% CI, 0.94–1.57), and the hazard of death from endometrial cancer remained significantly increased (HR, 2.27; 95% CI, 1.39–3.68). Both black and white women with a history of hypertension experienced a lower hazard of death from endometrial cancer (HR, 0.47; 95% CI, 0.23–0.98; and HR, 0.35; 95% CI, 0.19–0.67, respectively). CONCLUSION The higher prevalence of comorbid conditions among black women does not explain fully the racial disparities that are seen in endometrial cancer survival. The association between hypertension and a lower hazard of death from endometrial cancer is intriguing, and further investigation into the underlying mechanism is needed.

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“…12 While obesity may put patients at higher risk of surgical morbidity, Temkin et al and Modesitt et al showed that it was not an independent predictor of progression or overall survival but likely related to other comorbid conditions. 20,21 Given the possibility of multi-collinearity between individual comorbid conditions and survival, the use of a standardized comorbidity index while studying survival in EC patients is more appropriate.…”

Section: Commentsmentioning

confidence: 99%

“…9–11 Nicholas and colleagues showed that a diagnosis of diabetes and/or hypertension in EC patients resulted in a decreased survival even after adjusting for age, stage and grade. 12 Truong and colleagues studied the effect of age, Karnofsky performance status and Charlson comorbidity score on the treatment, recurrence and survival of EC patients. 13 They found that advanced age was associated with a decline in prescribed postoperative radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients

Binder

Peipert

Kallogjeri

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND The incidence of endometrial cancer increases with age and is associated with medical comorbidities such as obesity and diabetes. While a few cohort studies of less than 500 patients showed an association between comorbidity and survival in endometrial cancer patients, the degree of association needs to be better described. The Adult Comorbidity Evaluation 27 (ACE-27) is a validated comorbidity instrument that provides a score (0–3) based on the number and severity of medical comorbidities. OBJECTIVE This study was performed to explore the association between medical comorbidities and survival of endometrial cancer patients. STUDY DESIGN Patients diagnosed with endometrial cancer from 2000–2012 were identified from the prospectively maintained Siteman Cancer Center tumor registry. Patients undergoing primary surgical treatment for endometrioid, serous and clear cell endometrial carcinoma were included. Patients primarily treated with radiation, chemotherapy or hormone therapy were excluded. Patients with uterine sarcomas or neuroendocrine tumors were excluded. Patients with missing ACE-27 scores were also excluded from analysis. Information including patient demographics, ACE-27 score, tumor characteristics, adjuvant treatment and survival data were extracted from the database. The association of ACE-27 and overall as well as recurrence-free survival was explored in a multivariable Cox regression analysis after controlling for variables found to be significantly associated with survival in univariable analysis. RESULTS A total of 2073 patients with a median age of 61 years (range 20–94) at diagnosis were identified. ACE-27 score was 0, 1, 2 and 3 in 22%, 38%, 28% and 12% of patients, respectively. Stage distribution was I (73%), II (5%), III (15%) and IV (7%) and grade distribution was 1 (52%), 2 (23%) and 3 (25%). Most patients had endometrioid histology (87%) followed by serous (11%) and clear cell (3%). The median OS for the entire cohort was 54 months [95% confidence interval (CI) 3, 154 months] and median PFS was 50 months [95% CI 2, 154 months]. On univariable analysis, age, race, marital status, stage, grade, histology and treatment type were significantly associated with overall survival and recurrence-free survival. After adjusting for these covariates, patients with ACE-27 score of 2 had a 52% higher risk of death [95% CI 1.16, 2.00] and patients with ACE-27 score of 3 had a 2.35-fold increased risk of death [95% CI 1.73, 3.21] compared to patients with an ACE-27 score of 0. Similarly, patients with ACE-27 score of 2 had a 38% higher risk of recurrence [95% CI 1.07, 1.78] and patients with ACE-27 score of 3 had a 2.05-fold increased risk of recurrence [95% CI 1.53, 2.75] compared to patients with an ACE-27 score of 0. We found no interaction between ACE-27 score and age, stage or treatment type. CONCLUSIONS Our findings demonstrate the importance of comorbidities in estimating the prognosis of endometrial cancer patients, even after adjusting for age and known tumor-specific prognos...

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Impact of Comorbid Conditions on Survival in Endometrial Cancer

Abstract: In this study, DM and HTN adversely effected survival. Given the favorable survival rate for most patients with endometrial cancer, attention to comorbid conditions, and particularly DM and HTN, is becoming more relevant for its implications on current health care and policy.

Cited by 50 publications

References 2 publications

Lower Body Lymphedema in Patients with Gynecologic Cancer

Lower Body Lymphedema in Patients with Gynecologic Cancer

The influence of comorbid conditions on racial disparities in endometrial cancer survival

Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients

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