BACKGROUND.Patients with head and neck cancer are prone to develop significant comorbidity mainly because of the high incidence of tobacco and alcohol abuse, both of which are etiologic and prognostic factors. However, to the authors' knowledge little is known regarding the prognostic relevance of comorbidity in patients with salivary gland cancer.METHODS.A retrospective cohort of 666 patients with salivary gland cancer was identified within the Dutch Head and Neck Oncology Cooperative Group database. For multivariate analysis, a Cox proportional hazards model was used to study the effect of comorbidity on overall survival and diseaseâspecific survival.RESULTS.According to the Adult Comorbidity Evaluationâ27 (ACEâ27) index, 394 patients (64%) had grade 0 comorbidity, 119 patients (19%) had grade 1 comorbidity, 71 patients (12%) had grade 2 comorbidity, and 29 patients (5%) had grade 3 comorbidity. In multivariate analysis for overall survival, the ACEâ27 comorbidity grade was a strong independent prognostic variable. The hazards ratio (HR) of death, including all causes, was 1.5 (95% confidence interval [CI], 1.1â2.1) for patients with ACEâ27 grade 1 comorbidity versus grade 0 comorbidity (P < .007). The HR was 1.7 (95% CI, 1.2â2.5) for grade 2 comorbidity (P = .003) and 2.7 (95% CI, 1.5â4.7) for grade 3 comorbidity versus grade 0 comorbidity (P = .001). In the current analysis, ACEâ27 comorbidity grade was not an independent prognostic factor for diseaseâfree survival.CONCLUSIONS.To the authors' knowledge, this is the first study concerning the prevalence and relevance of the prognostic comorbidity variable ACEâ27 grade in patients with salivary gland cancer. Overall survival, but not diseaseâfree survival, was correlated strongly with ACEâ27 grade. Compared with other studies that investigated the effect of comorbidity on patients with head and neck cancer, patients with salivary gland cancer had less comorbidity. Their comorbid status appeared to be reasonably comparable to that of patients with other nonsmokingâ and nonalcoholârelated cancers. Cancer 2008. © 2008 American Cancer Society.