Development and external validation of nomograms predictive of response to radiation therapy and overall survival in nasopharyngeal cancer patients

Cho, Jae-Keun; Lee, Gil-Joon; Yi, Keun-Ik; Cho, Kyu‐Sup; Choi, Nayeon; Kim, Jong Se; Kim, Hakyoung; Oh, Dongryul; Choi, Sung Yong; Jung, Sin‐Ho; Jeong, Han‐Sin; Ahn, Yong Chan

doi:10.1016/j.ejca.2015.04.003

Cited by 44 publications

(41 citation statements)

References 39 publications

(44 reference statements)

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“…To our knowledge there are no models to predict survival in laryngeal cancer patients. Some survival prediction models exist for other head and neck cancer patients [29, 30]. The study [30] with a similar approach, large training and external validation cohorts found comparable results in model performance.…”

Section: Discussionmentioning

confidence: 97%

Implementation of a rapid learning platform: Predicting 2-year survival in laryngeal carcinoma patients in a clinical setting

et al. 2016

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Background and PurposeTo improve quality and personalization of oncology health care, decision aid tools are needed to advise physicians and patients. The aim of this work is to demonstrate the clinical relevance of a survival prediction model as a first step to multi institutional rapid learning and compare this to a clinical trial dataset.Materials and MethodsData extraction and mining tools were used to collect uncurated input parameters from Illawarra Cancer Care Centre's (clinical cohort) oncology information system. Prognosis categories previously established from the Maastricht Radiation Oncology (training cohort) dataset, were applied to the clinical cohort and the radiotherapy only arm of the RTOG-9111 (trial cohort).ResultsData mining identified 125 laryngeal carcinoma patients, ending up with 52 patients in the clinical cohort who were eligible to be evaluated by the model to predict 2-year survival and 177 for the trial cohort. The model was able to classify patients and predict survival in the clinical cohort, but for the trial cohort it failed to do so.ConclusionsThe technical infrastructure and model is able to support the prognosis prediction of laryngeal carcinoma patients in a clinical cohort. The model does not perform well for the highly selective patient population in the trial cohort.

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Section: Discussionmentioning

confidence: 97%

Implementation of a rapid learning platform: Predicting 2-year survival in laryngeal carcinoma patients in a clinical setting

et al. 2016

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“…Six studies on development of nomograms for NPC have been reported in recent years [5, 31–35]. They demonstrated feasibility of using nomogram to predict survival in NPC and consistently achieved superiority to the conventional TNM staging system.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the stronger predictive power of these nomograms, they suffered from important limitations including obsolete RT techniques [33–35] and lack of external validation [31, 33] that hampered their generalizability and validity in modern era. Furthermore, all were based on the 6–7th editions of AJCC/UICC staging system [5, 31–35]. With the imminent introduction of the 8 th edition, applicability of these nomograms will become outdated.…”

Section: Discussionmentioning

confidence: 99%

“…Variability in outcome among patients within the same stage receiving similar treatments is commonly observed; this could be attributed to heterogeneity in patient factors and other tumor factors. Literature review suggests the following potential alternative or additional prognostic factors may be useful: age [3, 4], gender [3], performance status [5], gross primary tumor volume (GTV-P) [6–9], lactate dehydrogenase (LDH) level [10–12], deoxyribonucleic acid (DNA) copies of Epstein-Barr Virus (EBV) [13–15], hemoglobin level [16]. Among these factors, EBV-DNA is a promising parameter, but not routinely available for all patients in most centers; the test methodology is difficult and requires further harmonization for global application [17].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity‐modulated radiotherapy

Pan

Zong

et al. 2016

Cancer

141

110

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Objective To develop a nomogram for refining prognostication for patients with non-disseminated nasopharyngeal cancer (NPC) staged with the proposed AJCC/UICC 8th edition. Material and methods Consecutive patients investigated by magnetic resonance imaging, staged by the proposed AJCC/UICC 8th edition, and irradiated by intensity- modulated radiotherapy (IMRT) from June 2005 to December 2010 were analyzed. The cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set and the results were validated by 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with concordance index (C-index). Patients were categorized into three risk groups by performing recursive partitioning algorithm (RPA) on the survival scores of the combined set. Results Multivariable analysis showed that age, gross primary tumor volume (GTV-P) and lactate dehydrogenase (LDH) were independent prognostic factors for OS in addition to stage-group. The OS nomogram based on all these factors had a statistically higher bias-corrected C-index than prognostication based on stage-group alone (0.712 vs 0.622, p<0.01). These results were consistent for both the training and the validation cohorts. Patients with <135 points were categorized as low-risk, ≥135–<160 points as intermediate-risk and ≥160 points as high-risk, respectively. Their 5-year OS rates were 92%, 84% and 58%, respectively. Conclusions The proposed nomogram could improve prognostication when compared with TNM stage-group. This could aid in risk stratification for individual NPC patients.

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“…Nomograms have been widely developed and applied in a variety of cancers [14–16], and nomograms with good performance have been introduced into NCCN guidelines [17]. Morever, several nomograms have been used to assist clinicians in making treatment and follow-up decisions in patients with head and neck cancers, including squamous cell carcinoma [18–21], adenoid cystic carcinoma [22] and nasopharyngeal cancer [23]. Two studies have reported the utility of nomograms for predicting the outcomes of patients with MSGC [5, 7], but both were based on a single population retrospective cohort and did not include patients who did not undergo surgery.…”

Section: Introductionmentioning

confidence: 99%

Nomograms for predicting long-term overall survival and cancer-specific survival in patients with major salivary gland cancer: a population-based study

Liu

et al. 2017

Oncotarget

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In this study, we aimed to develop and validate nomograms for predicting long-term overall survival (OS) and cancer-specific survival (CSS) in major salivary gland cancer (MSGC) patients. These nomograms were developed using a retrospective cohort (N=4218) from the Surveillance, Epidemiology, and End Results (SEER) database, and externally validated using an independent data cohort (N=244). We used univariate, and multivariate analyses, and cumulative incidence function to select the independent prognostic factors of OS and CSS. Index of concordance (c-index) and calibration plots were used to estimate the nomograms’ predictive accuracy. The median follow-up period was 34 months (1–119 months). Of 4218 MSGC patients, 1320 (31.3%) died by the end of the follow-up; of these 1320 patients, 883 (20.9%) died of MSGC. The OS nomogram, which had a c-index of 0.817, was based on nine variables: age, sex, tumor site, tumor grade, surgery performed, radiation therapy and TNM classifications. The CSS nomogram, which had a c-index of 0.829, was based on the same nine variables plus race. External validation c-indexes were 0.829 and 0.807 for OS and CSS, respectively. Based on SEER database, we have developed nomograms predicting five- and eight-years OS and CSS for MSGC patients with perfect accuracy. These nomograms will help clinicians customize treatment and monitoring strategies in MSGC patients.

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Development and external validation of nomograms predictive of response to radiation therapy and overall survival in nasopharyngeal cancer patients

Cited by 44 publications

References 39 publications

Implementation of a rapid learning platform: Predicting 2-year survival in laryngeal carcinoma patients in a clinical setting

Implementation of a rapid learning platform: Predicting 2-year survival in laryngeal carcinoma patients in a clinical setting

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity‐modulated radiotherapy

Nomograms for predicting long-term overall survival and cancer-specific survival in patients with major salivary gland cancer: a population-based study

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