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Alvaro Sanabria, MD, MSc, PhD; André Lopes Carvalho, MD, PhD; José Guilherme Vartanian, MD, PhD; José Magrin, MD, PhD; Mauro Kasuo Ikeda, MD, PhD; Luiz Paulo Kowalski, MD, PhD

Arch Otolaryngol Head Neck Surg. 2008;134(6):603-607.

Objectives  To validate the prognostic ability of the Washington University Head and Neck Comorbidity Index (WUHNCI) relative to 5-year survival in a cohort of older patients with head and neck cancer and to compare it with that of the Adult Comorbidity Evaluation 27 (ACE-27).

Design  Validation study.

Setting  Academic research.

Patients  Three hundred twenty-one patients older than 70 years with head and neck cancer in a tertiary cancer center. Comorbidity was measured using the ACE-27, WUHNCI, and National Cancer Institute (NCI) comorbidity index.

Main Outcome Measure  Five-year overall survival.

Results  Five-year overall and cancer-specific survival, respectively, were as follows: Using the WUHNCI, 52.2% and 62.9% for a score of 0; 25.1% and 41.7% for a score of 1; 39.3% and 64.9% for a score of 2; and 19.5% and 45.0% for a score of 3 or higher. Using the ACE-27, 54.4% and 61.7% for a score of 0 (no comorbidity); 46.8% and 61.7% for a score of 1 (mild comorbidity); 31.7% and 51.6% for a score of 2 (moderate comorbidity); and 13.8% and 43.7% for a score of 3 (severe comorbidity). The C statistics were 0.641 for the NCI comorbidity index, 0.656 for the ACE-27, and 0.686 for the WUHNCI.

Conclusions  The WUHNCI did not demonstrate good discriminative power compared with the ACE-27 in a cohort of older patients. To be widely used, instruments developed to measure comorbidities must be reliable in any population. We believe that the ACE-27 is still the best index to assess comorbidities and that it should be used in studies evaluating the prognostic effect of comorbidities.

Author Affiliations: Department of Surgery, School of Medicine, Universidad de La Sabana, Fundación Abood Shaio, Bogotá, Colombia (Dr Sanabria); and Department of Head and Neck Surgery and Otorhinolaryngology, Hospital do Câncer A. C. Camargo, Fundação Antonio Prudente, São Paulo, Brazil (Drs Carvalho, Vartanian, Magrin, Ikeda, and Kowalski).