Preoperative nomogram based on CT imaging to predict recurrence of early-stage glottic cancer after larynx-preserving surgery

Abstract

Background The aim of this research is to explore the difference in clinicopathologic and CT features of early-stage glottic cancer (EGC) with or without recurrence after larynx-preserving surgery (LPS), and to establish a preoperative nomogram for predicting postoperative recurrence. Methods The clinicopathologic and CT features of 98 consecutive patients with EGC were analyzed retrospectively. Independent predictors for recurrence were determined by multivariate logistic regression analysis and presented with a nomogram. A Harrell’s concordance index (C-index) and a calibration plot were used to assess the performance of the nomogram. The clinical net benefit of the model was evaluated using decision curve analysis (DCA). Results There were significant differences in T stage, depth, and normalized CT value (NCT) in arterial phase (NCTAP) and NCT in the venous phase (NCTVP) between with and without recurrence group (all P < 0.05). T stage, depth, and NCTVP were independent predictors of recurrence (Odds ratio [OR] 3.27, 95% confidence interval [CI] 1.70–7.27, P = 0.016; OR 5.02, 95% CI 1.65–14.08, P = 0.005, and OR 3.60, 95% CI 2.55–9.63, P = 0.017, respectively). The C-index showed that the nomogram (0.790, 95%CI: 0.675–0.904) has good prediction performance and better than T stage (C-index, 0.619, 95%CI: 0.508–0.730). The calibration curve showed that the predicted probabilities of the nomogram were in good agreement with the actual probabilities, and DCA indicated that it provided more net benefit than the treat-none or treat-all scheme. Conclusions CT could provide independent recurrence indicators in patients with EGC, and the developed nomogram may be a potential noninvasive tool to guide personalized treatment.