A novel prognostic model predicting the long-term cancer-specific survival for patients with hypopharyngeal squamous cell carcinoma

Abstract

Background Hypopharyngeal squamous cell carcinoma (HSCC) is a rare type of head and neck cancer with poor prognosis. However, till now, there is still no model predicting the survival outcomes for HSCC patients. We aim to develop a novel nomogram predicting the long-term cancer-specific survival (CSS) for patients with HSCC and establish a prognostic classification system. Methods Data of 2021 eligible HSCC patients were retrieved from the Surveillance, Epidemiology and End Results database between 2010 and 2015. We randomly split the whole cases (ratio: 7:3) into the training and the validation cohort. Cox regression as well as the Least absolute shrinkage and selection operator (LASSO) COX were used to select significant predictors of CSS. Based on the beta-value of these predictors, a novel nomogram was built. The concordance index (C-index), the calibration curve and the decision curve analysis (DCA) were utilized for the model validation and evaluation using the validation cohort. Results In total, cancer-specific death occurred in 974/2021 (48.2%) patients. LASSO COX indicated that age, race, T stage, N stage, M stage, surgery, radiotherapy and chemotherapy are significant prognosticators of CSS. A prognostic model based on these factors was constructed and visually presented as nomogram. The C-index of the model was 0.764, indicating great predictive accuracy. Additionally, DCA and calibration curves also demonstrated that the nomogram had good clinical effect and satisfactory consistency between the predictive CSS and actual observation. Furthermore, we developed a prognostic classification system that divides HSCC patients into three groups with different prognosis. The median CSS for HSCC patients in the favorable, intermediate and poor prognosis group was not reached, 39.0-Mo and 10.0-Mo, respectively (p < 0.001). Conclusions In this study, we constructed the first nomogram as well as a relevant prognostic classification system that predicts CSS for HSCC patients. We believe these tools would be helpful for clinical practice in patients’ consultation and risk group stratification.

Development and validation of a nomogram to predict cancer-specific survival in patients with hypopharyngeal squamous cell carcinoma treated with primary surgery

“…However, recent evidence suggests that the current AJCC stage classification has many limitations in terms of accurately revealing patients’ risk. 7 – 9 , 17 – 19 First, AJCC staging does not include factors like age, ethnicity, marital status, and preoperative blood parameters, which have been associated with prognosis in previous studies. 7 – 9 Second, some pathologic characteristics like histologic features, tumor size, number of positive lymph nodes, and positive lymph node ratio are also associated with prognosis but cannot be completely revealed using conventional AJCC staging.…”

“… 7 – 9 , 17 – 19 First, AJCC staging does not include factors like age, ethnicity, marital status, and preoperative blood parameters, which have been associated with prognosis in previous studies. 7 – 9 Second, some pathologic characteristics like histologic features, tumor size, number of positive lymph nodes, and positive lymph node ratio are also associated with prognosis but cannot be completely revealed using conventional AJCC staging. 17 – 19 Thus, a more comprehensive model is urgently needed for risk stratification in patients with HSCC.…”

“…Older age and unmarried status have been reported as adverse prognostic factors. 7 , 8 , 22 In our study, we incorporated the above five factors into the nomogram, which was found to be superior to conventional AJCC stage. Therefore, the nomogram is not only user friendly (includes only six factors that are easily accessible), it can help clinicians to perform better risk stratification.…”

“…Moreover, previous prognostic models were mainly developed using population-based studies and non-surgical treatment, which may limit their application in those treated with surgery owing to different treatment modalities. 7 , 8 Therefore, in our study, we aimed to develop and validate a nomogram that could accurately predict the survival in patients undergoing primary surgery, which can help clinicians perform better risk stratification.…”

Second Primary Malignancy in Patients with Hypopharyngeal Carcinoma: A SEER-Based Study

“… 22 , 23 Then, Lin et al, Tang, Gong et al and Tian et al constructed nomograms for predicting survival in patients with hypopharyngeal squamous-cell carcinoma. 12 , 24 , 25 However, SPM was not included in their nomograms. Our study is the first study of SPM in patients with HPC.…”