Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer

Abstract

Purpose Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and cross-validation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P = .003;< .001). Conclusion The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

“…In previous studies, multifocal lesions, large tumor size, advanced neoplasm grade, and high serum AFP level have been reported to increase the possibility of vascular invasion in advanced HCC (33)(34)(35). In the present study, abnormal AFP level, an independent risk factor for MVI, was also significantly associated with MVI.…”

Individualized survival prediction for patients with oropharyngeal cancer in the human papillomavirus era

“…18 While these trials included patients with HNC of multiple subsites, only patients with OPSCC were used to generate this model. This data source is advantageous in that patient, treatment, and outcome data would be expected to be relatively homogenous, complete, and accurate.…”

“…We identified four calculators: one developed at the MAASTRO Clinic (“MAASTRO”), 20 one based on data from Radiation Therapy Oncology Group (RTOG) trials (“RTOG”), 18 one based on patients treated in eastern Denmark (“Denmark”), 19 and one developed at Erasmus Medical Center (EMC) (“Erasmus”). 21, 23 Table 1 summarizes the data sources of each calculator, with additional details provided in Supplemental Tables 1–4.…”

“… * These represent uncorrected values; bias-corrected values are available in the corresponding published reports 18, 19 . OPSCC = oropharyngeal squamous cell carcinoma. C-index = concordance statistics.…”

Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes

“…Summarizing a compendium of previously-published data, Lau and Iyengar take the novel approach of focusing on weight loss in cancer patients who are receiving radiation [6]. Only recently, Fakhry and others added yet another such study that looks at radiation in over 600 patients with oropharyngeal cancer and observed that weight loss is associated with shorter cancer progression-free survival [7]. Such studies join countless others that have reached the exact same conclusion: weight loss in cancer patients is associated with poor clinical outcomes.…”