Development of comprehensive nomograms for evaluating overall and cancer-specific survival of laryngeal squamous cell carcinoma patients treated with neck dissection

Oncotarget. 2017 May 2;8(18):29722-29740. doi: 10.18632/oncotarget.15414.

Abstract

Background: Neck dissection for laryngeal squamous cell carcinoma (LSCC) patients could provide complementary prognostic information for AJCC N staging, like lymph node ratio (LNR). The aim of this study was to develop effective nomograms to better predict survival for LSCC patients treated with neck dissection.

Results: 2752 patients were identified and randomly divided into training (n = 2477) and validation (n = 275) cohorts. The 3- and 5-year probabilities of cancer-specific mortality (CSM) were 30.1% and 37.2% while 3- and 5-year death resulting from other causes (DROC) rate were 6.2% and 11.3%, respectively. 13 significant prognostic factors including LNR for overall (OS) and 12 (except race) for CSS were enrolled in the nomograms. Concordance index as a commonly used indicator of predictive performance, showed the nomograms had superiority over the no-LNR models and TNM classification (Training-cohort: OS: 0.713 vs 0.703 vs 0.667, CSS: 0.725 vs 0.713 vs 0.688; Validation-cohort: OS: 0.704 vs 0.690 vs 0.658, cancer-specific survival (CSS): 0.709 vs 0.693 vs 0.672). All calibration plots revealed good agreement between nomogram prediction and actual survival.

Materials and methods: We identified LSCC patients undergoing neck dissection diagnosed between 1988 and 2008 from Surveillance, Epidemiology, and End Results (SEER) database. Optimal cutoff points were determined by X-tile program. Cumulative incidence function was used to analyze cancer-specific mortality (CSM) and death resulting from other causes (DROC). Significant predictive factors were used to establish nomograms estimating overall (OS) and cancer-specific survival (CSS). The nomograms were bootstrapped validated both internally and externally.

Conclusions: Comprehensive nomograms were constructed to predict OS and CSS for LSCC patients treated with neck dissection more accurately.

Keywords: cancer-specific survival; laryngeal squamous cell carcinoma; lymph node ratio; nomogram; overall survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / surgery
  • Cause of Death
  • Female
  • Humans
  • Incidence
  • Laryngeal Neoplasms / diagnosis
  • Laryngeal Neoplasms / epidemiology
  • Laryngeal Neoplasms / mortality*
  • Laryngeal Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Nomograms
  • Reproducibility of Results
  • SEER Program
  • Survival Rate
  • Treatment Outcome
  • Tumor Burden
  • Young Adult