Association of Charlson–Deyo Comorbidity Index With Survival Following Upfront Laryngectomy for Laryngeal Squamous Cell Carcinoma

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Abstract
Objective: Charlson–Deyo Comorbidity Index (CCI) predicts 10‐year mortality for a patient based on a range of comorbid conditions. Objective preoperative risk assessment tools inform physician decision making. Our study examines the relationship between CCI and overall survival (OS) following upfront laryngectomy for laryngeal squamous cell carcinoma (LSCC). Methods: A retrospective analysis of the 2004–2016 National Cancer Database (NCDB) was conducted to identify adult patients with pT1‐4 N0‐3 M0 LSCC undergoing upfront laryngectomy. Kaplan–Meier survival analysis and Cox proportional hazards modeling were performed to evaluate the association between CCI and OS. Results: Of the 25,720 patients satisfying inclusion criteria, 16,204 (63.0%) were CCI = 0, 6812 (26.5%) were CCI = 1, 1948 (7.6%) were CCI = 2, and 756 (2.9%) were CCI ≥ 3. On univariate analysis, CCI groups differed by age (65.1% were < 65 years old in CCI = 0 vs. 57.3%, 49.6%, and 48.9% in CCI = 1, 2, and ≥ 3; p < 0.001), sex ( p < 0.001), and race ( p < 0.001). Differences also existed across CCI groups in primary site, T‐stage, N‐stage, systemic therapy, and radiotherapy ( p < 0.001). On Kaplan–Meier analysis, 5‐year OS for CCI = 0, 1, 2, and ≥ 3 was 55.3%, 47.8%, 39.5%, and 34.0%, respectively ( p < 0.001). CCI = 1 (aHR 1.20, 95% CI 1.14–1.26, p < 0.001), CCI = 2 (aHR 1.57, 95% CI 1.45–1.71, p < 0.001), and CCI ≥ 3 (aHR 1.77, 95% CI 1.56–2.01, p < 0.001) were associated with worse OS than CCI = 0. Conclusion: In an adult cohort with pT1‐4 N0‐3 M0 LSCC undergoing upfront laryngectomy, increasing CCI was associated with worse OS. During perioperative counseling, CCI should be optimized and considered as a factor influencing survival outcomes. Level of Evidence: 4.

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