Author(s)
David Herz, BS
Aman M. Patel, BS
George Bebawy, BA
Anthony Saad, Medical Student
Ghayoour Mir, DO
Andrey Filimonov, MD, PharMD
Affiliation(s)
Rutgers New Jersey Medical School;
Abstract:
Objective: Objective preoperative risk assessment tools inform physician and patient decision making. Our study examines the relationship between the Charlson-Deyo Comorbidity Index (CCI) and overall survival (OS) following surgery for sinonasal squamous cell carcinoma (SNSCC).
Methods: The 2004-2016 National Cancer Database (NCDB) was used to extract adult patients with pT1-4 N0-3 M0 SNSCC undergoing surgery. Kaplan-Meier survival analysis and Cox-Proportional Hazards modeling were used to analyze the impact of CCI on OS.
Results: Of the 3,494 patients satisfying inclusion criteria, 2,749 (79%) were CCI=0, 575 (16%) were CCI=1, and 170 (5%) were CCI=2+. On univariate analysis, CCI groups differed by age (43% were =65 years old in CCI=0 vs 53% and 64% in CCI groups 1 and 2+, respectively, p<0.001). There was no significant difference between CCI groups in race, sex, T-stage, N-stage, margin status, primary site, radiation therapy, or systemic therapy. On Kaplan-Meier analysis, 5-year OS for CCI=0, CCI=1, and CCI=2+ was 44.3%, 41.5%, and 37.0%, respectively (p<0.001). However, CCI=1 (HR 0.81, 95% CI 0.52-1.27, p=0.357), and CCI=2+ (HR 1.55, 95% CI 0.81-2.98, p=0.186) were not associated with worse OS than CCI=0.
Conclusions: In a cohort of adult patients with SNSCC undergoing surgery, increasing CCI was not associated with worse OS, although different groups did have significantly different OS. These findings indicate that CCI may not adequately capture the complexities of frailty in this population. Future studies should explore alternative frailty indices or more comprehensive risk assessment tools that better predict survival outcomes in SNSCC, potentially improving surgical decision making and individualized care.