Adult comorbidity evaluation 27 score in endometrial cancer patient




I read with interest the article by Binder et al regarding adult comorbidity evaluation 27 (ACE-27) score in women with endometrial cancer; we agree with the authors in that medical comorbidity is a very important prognostic factor in women with endometrial cancer. Additionally, quantification of the comorbidity burden is as equally important with the use of available comorbidity indices such as age-adjusted Charlson Comorbidity and ACE-27 scores. Furthermore, finding the appropriate comorbidity index with the best predictive validity in women with endometrial carcinoma has important clinical implications. Although we believe that the study by Binder et al is an important one, we also believe that ACE-27 is not the best tool to quantify comorbidity burden in women with type I because one of the ACE-27 components is obesity (defined as body mass index ≥38 kg/m 2 ). Knowing that 70–90% of women with type I endometrial cancer are obese, scoring comorbidity burden with ACE-27 index will introduce bias, because the majority of patients with type I EC will obtain a minimum score of ≥2 or higher. We were surprised to see that an ACE-27 score of 2 is only 28% in the current study.


We also think that comorbidity burden in this population increases with aging. As time passes, new serious conditions may emerge that subsequently may lead to a detriment in a patient’s survival. We were wondering at what point of time the ACE-27 score was documented in the current study?


Knowing the significant difference in patient demographics (mainly body mass index in women with type I vs type II endometrial carcinoma), we believe that the impact of comorbidity burden could be illustrated easily if we are looking at a more uniform group of patients who had similar histologic subtypes and stages.


In conclusion, the study by Binder et al is an important addition to the literature that potentially would increase the awareness of researchers with the very important impact of comorbidity burden in the prediction of survival endpoints in women with endometrial carcinoma.

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Apr 24, 2017 | Posted by in GYNECOLOGY | Comments Off on Adult comorbidity evaluation 27 score in endometrial cancer patient

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