Faculty Collaboration Database

Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer. J Clin Oncol 2017 Dec 20;35(36):4057-4065

Date

08/05/2017

Pubmed ID

28777690

Pubmed Central ID

PMC5736236

DOI

10.1200/JCO.2016.72.0748

Scopus ID

2-s2.0-85033804691 (requires institutional sign-in at Scopus site)   115 Citations

Abstract

Purpose Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and cross-validation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P = .003;< .001). Conclusion The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.

Author List

Fakhry C, Zhang Q, Nguyen-Tân PF, Rosenthal DI, Weber RS, Lambert L, Trotti AM 3rd, Barrett WL, Thorstad WL, Jones CU, Yom SS, Wong SJ, Ridge JA, Rao SSD, Bonner JA, Vigneault E, Raben D, Kudrimoti MR, Harris J, Le QT, Gillison ML

Author

Stuart J. Wong MD Center Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antineoplastic Combined Chemotherapy Protocols
Carcinoma, Squamous Cell
Chemoradiotherapy
Cohort Studies
Disease-Free Survival
Female
Head and Neck Neoplasms
Humans
Male
Middle Aged
Nomograms
Organoplatinum Compounds
Oropharyngeal Neoplasms
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Randomized Controlled Trials as Topic
Survival Rate