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

Abstract

Background: Accurate, individualized prognostication in oropharyngeal squamous cell carcinoma (OPSCC) is vital for patient counseling and treatment decision-making. With the emergence of human papillomavirus (HPV) as an important biomarker in OPSCC, calculators incorporating this variable have been developed. However, it is critical to characterize their accuracy prior to implementation. Methods: Four OPSCC calculators were identified that integrate HPV in their estimation of five-year overall survival. Treatment outcomes for 856 patients with OPSCC evaluated at a single institution from 2003–2016 were analyzed. Predicted survival probabilities were generated for each patient using each calculator. Calculator performance was assessed and compared using Kaplan-Meier plots, receiver operating characteristic (ROC) curves, concordance statistics (C-indices), and calibration plots. Results: Correlation between pairs of calculators varied, with coefficients ranging from 0.63 to 0.90. Only three of six pairs of calculators yielded predictions within 10% of each other for at least 50% of patients. Kaplan-Meier curves of calculator-defined risk groups showed reasonable stratification. Areas under the ROC curve ranged from 0.74 to 0.80, and C-indices from 0.71 to 0.78. Each calculator demonstrated superior discriminatory ability compared to American Joint Committee on Cancer 7th and 8th Editions clinical staging. Among models, the Denmark calculator was best-calibrated to observed outcomes. Conclusions: Existing calculators exhibited reasonable estimation of survival in OPSCC, but there was considerable variability in predictions for individual patients, which limits clinical utility. Given the increasing role of personalized treatment for OPSCC, further work is needed to improve accuracy and precision, possibly through the identification and incorporation of additional biomarkers.

Potential Added Value of PET/CT Radiomics for Survival Prognostication beyond AJCC 8th Edition Staging in Oropharyngeal Squamous Cell Carcinoma

“…It should be noted that C-indices reported for AJCC models in our study were averaged across validation folds in repeated cross-validation analysis utilizing overall stage and T-/N-stage as prognostic variables, which is methodologically different from some prior studies [33][34][35]. Dissimilarities in analysis methodology, sample size, length of follow-up, and numbers of events may have contributed to the differences between AJCC model C-indices in our study and prior reports.…”

Hippo Pathway and YAP Signaling Alterations in Squamous Cancer of the Head and Neck

“…One of the main problems in the field of targeted therapies in HNSCC is the complete lack of biomarker-based patient selection to allow stratification into subgroups with different therapeutic options, even for the aforementioned molecularly based therapies. The presence of high-risk HPV in oropharyngeal cancer is the only molecular marker currently used for risk stratification [32].…”

A multi‐objective radiomics model for the prediction of locoregional recurrence in head and neck squamous cell cancer

“…6,[18][19][20][21][22] For patients with HNSCC in oropharynx, prospective clinical trial and retrospective analysis have shown that HPV status is strongly associated with therapeutic response and survival. [19][20][21] In the studies of HNSCC patient treatment response and survival prediction, age, tumor primary site, tumor T-stage, and tumor N-stage are found contributing significantly to overall survival. 6,18 The design of the objective function is also of great importance when building radiomics models.…”