A Predictive Mortality Model for Advanced Oropharyngeal Cancer Patients Treated with Chemoradiation

Abstract

Background: To analyze clinical characteristics in the prediction of early mortality (within 1 year) in advanced oropharyngeal cancer patients treated with chemoradiation. Methods: 147 advanced oropharyngeal cancer patients who underwent curative-intent chemoradiation treatment were retrospectively enrolled. The pre-treatment clinical parameters including inflammatory markers were reviewed.Results: The 1-year overall mortality for all patients was 29% [95% confidence interval (CI): 23-37%]. In multivariate logistic regression analysis, hemoglobulin (Hb) < 13.5 gm/dl was an independent indicator of early mortality [Odds ratio (OR) 5.85, 95% CI 2.17-15.75, p < 0.001]. Systemic immune inflammation (SII) ≥ 1820 was also a significant factor for prediction of early mortality (OR 4.78, 95% CI 1.44-15.85, p = 0.011). We further used gander, age, Hb and SII to develop a nomogram to predict early mortality. The c-index of the model was 0.75 (95%CI 0.66-0.83). For patients with low nomogram score (< 14) versus high nomogram score (≥ 14), the 1-year and 2-year OS rates were 91% and 71% versus 53% and 29%, respectively. (p < 0.001). A difference in the disease persistence or recurrence rate between patients with high and low nomogram score was significant (73% and 28%, respectively; p < 0.001). Conclusions: The pre-treatment Hb < 13.5 gm/dl and SII ≥ 1820 are associated with higher risks of early mortality in patients with advanced oropharyngeal cancers. Nomogram can aid in patient counseling and treatment modality adjustment. The development of a more effective treatment protocol for patients with high nomogram score will be essential.