A Prognostic Nomogram Incorporating Depth of Tumor Invasion to Predict Long-term Overall Survival for Tongue Squamous Cell Carcinoma With R0 Resection

Abstract

Purpose: To establish a useful prognostic nomogram to predict long-term overall survival for patients with tongue squamous cell carcinoma (TSCC) after R0 resection.Patients and Methods: The nomogram was developed using a retrospective cohort of 235 TSCC patients from Sun Yat-sen University Cancer Center between 1 January 2000 and 31 December 2007. An independent dataset of 223 patients was used for external validation. Multivariate Cox proportional hazards model (backward selection; the Akaike information criteria) was applied to select variables for construction of the nomogram. Discrimination and calibration were performed using the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots.Results: Using the backward selection of clinically-relevant variables, depth of invasion (hazard ratio [HR], 3.55; P < 0.001), pN (HR, 3.48; P = 0.01), age (HR, 1.03; P < 0.01) and neck dissection (HR, 0.53; P = 0.04) were selected as independent predictive factors of survival. A nomogram was thus established to predict survival of TSCC patients after R0 resection. The calibration curve demonstrated that the nomogram was able to accurately predict 5-year overall survival (OS). In addition, our data showed the AUC of the nomogram were 0.78 and 0.71 based on the internal and external validation, which were significantly better than the 7th TNM stage (0.64/0.55).Conclusion: The proposed nomogram resulted in accurate prognostic prediction of the 5-year OS for TSCC patients with R0 resection.

Depth of invasion for prognostic stratification in oral cavity cancer: do we need further validation?

“…The present data reinforce the concept that DOI correlates well with the risk of nodal metastasis in oral cavity SCC (2,8,9,13), with a risk of loco-regional recurrence that increases for any DOI, in a clinically negative neck, with a sharp cumulative risk from 2 to 6 mm (2,8). As noted many years ago, nodal metastasis has a profound and dismal impact on prognosis, with a 50% reduction of 5-year DSS in patients showing positive neck nodes (1).…”

“…From this observation, it directly derives that other factors should be taken into account when studying prognosis of oral cavity and, particularly, tongue SCC, as they all might play a role, heavily influencing the risk of nodal metastasis and survival. Nomograms and prediction models, developed using large (but retrospective) cohorts, showed excellent accuracy for predicting 5-year OS or determining the probability of nodal metastasis (8,20,21). These models use many other clinically-relevant variables such as age, pattern of invasion, perineural and lympho-vascular involvement, or primary site of cancer occurrence to correlate with OS or nodal metastasis (8,20,21).…”

“…Nomograms and prediction models, developed using large (but retrospective) cohorts, showed excellent accuracy for predicting 5-year OS or determining the probability of nodal metastasis (8,20,21). These models use many other clinically-relevant variables such as age, pattern of invasion, perineural and lympho-vascular involvement, or primary site of cancer occurrence to correlate with OS or nodal metastasis (8,20,21). It might be that these factors could obfuscate the role played by DOI and tumor size in separating T1 from T2 diseases.…”

“…In fact, in response to growing evidence, a well-known pathological feature, namely depth of invasion (DOI), was introduced as a fundamental staging criterion to define T1, T2, and T3 categories as it shows significant correlation with disease specific survival (DSS) (6,7). Moreover, DOI correlates well with the risk of nodal metastasis and loco-regional recurrence, especially in tongue SCC (1,2,6,8,9). Extranodal extension was also added to the N classification of every non-viral related tumor of the upper aero-digestive tract, given its profound negative effect on prognosis in terms of not only regional, but also local and distant relapses (7).…”

Personalized prognostication in head and neck cancer: A systematic review of nomograms according to the AJCC precision medicine core (PMC) criteria

“…The level of agreement for the second phase was 88% with a kappa of 0.77. A total of 44 studies remained for the final analysis . The list of excluded papers with the reasons for exclusion can be found in the Supporting Information S3.…”