Validation of the Charlson Comorbidity Index in Patients With Head and Neck Cancer: A Multi‐institutional Study

Abstract

Comorbid conditions are medical illnesses that accompany cancer. The impact of these conditions on the outcome of patients with head and neck cancer is well established. However, all of the comorbidity studies in patients with head and neck cancer reported in the literature have been performed using the Kaplan-Feinstein index (KFI), which may be too complicated for routine use. This study was performed to introduce and validate the use of the Charlson comorbidity index (CI) in patients with head and neck cancer and to compare it with the Kaplan-Feinstein comorbidity index for accuracy and ease of use. Study design was a retrospective cohort study. The study population was drawn for three academic tertiary care centers and included 88 patients 45 years of age and under who underwent curative treatment for head and neck cancer. All patients were staged by the KFI and the CI for comorbidity and divided into two groups based on the comorbidity severity staging. Group 1 included patients with advanced comorbidity (stages 2 or 3), and group 2 included those with low-level comorbidity (stages 0 or 1). Outcomes were compared based on these divisions. The KFI was successfully applied to 80% of this study population, and the CI was successfully applied in all cases (P < 0.0001). In addition, the KFI was found to be more difficult to use than the CI (P < 0.0001). However, both indices independently predicted the tumor-specific survival (P = 0.007), even after adjusting for the confounding effects of TNM stage by multivariate analysis. Overall, the CI was found to be a valid prognostic indicator in patients with head and neck cancer. In addition, because comorbidity staging by the CI independently predicted survival, was easier to use, and more readily applied, it may be better suited for use for retrospective comorbidity studies.

A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson's index

“…This index has been validated in a cohort of breast cancer patients (Charlson et al, 1987), giving a method of measuring the prognostic impact of comorbid disease. Since this initial publication, the CCI has been validated and used in several cancer studies (head and neck (Singh et al, 1997), stomach (Lubke et al, 2003), bladder (Miller et al, 2003), kidney (Gettman et al, 2003), prostate (Froehner et al, 2003)) including lung cancer (Firat et al, 2002a;Birim et al, 2003a) and cancer in the elderly (Extermann et al, 1998). In our study, we developed and validated a new SCS.…”

“…Comorbid conditions are frequent in NSCLC patient populations, considering the mean age and the high frequency of smokers of this population. Comorbidities are considered as an important prognostic factor in patients with different types of cancer, including lung cancer (Feinstein et al, 1977;Wells et al, 1984;Clemens et al, 1986;Feinstein and Wells, 1990;Miller et al, 1992;Waldman and Potter, 1992;Piccirillo et al, 1994;Satariano and Ragland, 1994;Piccirillo and Feinstein, 1996;Rochon et al, 1996;Pugliano et al, 1997;Singh et al, 1997;Extermann et al, 1998;Firat et al, 2002a). Comorbidities may impair survival by themselves or by affecting the therapeutic options.…”

A genetic view of laryngeal cancer heterogeneity

“…9,10 The main prognostic factor for overall survival (OS) is tumor staging, where node invasion is more relevant than tumor extension. 11 Other OS prognostic factors are patient's comorbidity, performance status-ECOG (PS), 12 persistent toxic consumption habits, 13 second primary tumor appearance 14 and primary tumor localization. In general, the supra and subglottic cancers have worse prognosis than glottic cancers, which 5-year survival is 82% for early stages possibly related to early detection.…”

“…In general, the supra and subglottic cancers have worse prognosis than glottic cancers, which 5-year survival is 82% for early stages possibly related to early detection. 15 Moreover, PS, 12,16 node invasion 16,17 and localization 12 are prognostic factors for disease-free survival in conjunction with pathologic stage (pT), 17 surgical resection margins 16 and pretreatment tracheotomy. 18 Moreover, T4 primary extension and more than 2 cm tumoral invasion of the base of the tongue were shown to be associated with increased salvage laryngectomy in the Veterans study.…”

The hematopoietic stem cell transplantation comorbidity index is of prognostic relevance for patients with myelodysplastic syndrome

“…2 There are several scoring systems to evaluate comorbidity. The Charlson Comorbidity Index (CCI), which considers the one-year mortality of internal medicine inpatients and proved its relevance for patients with solid cancer, [3][4][5] was established in 1987 by Mary Charlson. 6 It is a weighted scoring system based on 19 items which in general can easily be assessed retrospectively from the patients' charts (Online Supplementary Appendix).…”