Predictive value of the Adult Comorbidity Evaluation 27 on adverse surgical outcomes and survival in elderly with advanced epithelial ovarian cancer undergoing cytoreductive surgery

Abstract

Objective: We aimed to evaluate the ability of Adult Comorbidity Evaluation 27 (ACE-27) to predict perioperative outcomes and survival in elderly women with advanced epithelial ovarian cancer (AEOC) that underwent cytoreductive surgery. Methods: We collected patients with AEOC in our hospital between January 1, 2012 and January 1, 2021, excluding patients younger than 65 years or those with non-epithelial ovarian cancer. ACE-27 was applied retrospectively to evaluate comorbidities in the selected patients. The patients included were classified into two groups, low ACE-27 score group (none to mild) and high ACE-27 score group (moderate to severe). Results: A total of 222 elderly women with AEOC were included, of whom 164 patients accepted debulking surgery. Among those who have undergone surgery, Clavien-Dindo grade III+ perioperative complications or unintended intensive care unit (ICU) admission occurred more often in patients of high ACE-27 score group, with statistically significant difference (odds ratio [OR]: 4.21, 95% confidence interval [CI], 1.28-14.35, p = 0.018). Kaplan-Meier survival curves analyzed by Log-Rank test showed that the overall survival (OS) of patients with severe comorbidities were shorter than with none to moderate (HR 3.25, 95%CI 1.55-6.79, p=0.002). Further stratified analyses by age, BMI, FIGO stage and pathology also prove that OS of patients graded severe was shorter than patients graded none to moderate in cohort of age < 70, BMI < 25 kg/m2, FIGO III stage and pathology of serous, respectively. Conclusions: Our findings demonstrate the ability of ACE-27 to predict grade III+ perioperative complications or unintended ICU admission and survival in elderly patients with AEOC. This tool for comorbidity assessment may identify patients with AEOC at higher risk of adverse surgical outcomes, poor overall survival, and assist in decisions regarding treatment.