Charlson–Deyo Index Impact on Overall Survival After Surgery for Sinonasal Squamous Cell Carcinoma

Abstract

Objectives

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

In a retrospective cohort study, the 2004–2016 National Cancer Database was used to extract adult patients with pT1-4N0-3 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 3307 patients satisfying inclusion criteria, 2613 (79.0%) were CCI = 0, 533 (16.1%) were CCI = 1, and 161 (4.9%) were CCI = 2+. On univariate analysis, CCI groups differed by age (42.8% were ≥ 65 years old in CCI = 0 vs. 53.3% and 64.0% in CCI groups 1 and 2+, respectively, p < 0.001) and race (p < 0.001). There was no significant difference between CCI groups in 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 58.6%, 48.0%, and 42.9%, respectively (p < 0.001). CCI = 1 (HR 1.20, 95% CI 0.99–1.45, p = 0.069) was not associated with worse OS than CCI = 0. CCI = 2+ (HR 1.43, 95% CI 1.05–1.96, p = 0.025) was associated with worse OS than CCI = 0.

Conclusions

In a cohort of adult patients with SNSCC undergoing surgery, higher CCI was independently associated with worse OS. These findings support the use of CCI as a predictor of postoperative outcomes in SNSCC patients. Future studies should explore how comorbidity burden interacts with frailty and other prognostic factors to refine risk stratification tools.

Level of Evidence

4