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Prognostic risk factors for initially diagnosed T2N0M0 glottic cancer: competing risk analysis and propensity-score matched cohort analysis

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Abstract

Background

Prognostic risk factors of patients with initially diagnosed T2N0M0 glottic cancer remain unclear. This study was aimed to conduct a comprehensive analysis to identify valuable prognostic risk factors for initially diagnosed T2N0M0 glottic cancer.

Methods

Data of patients with initially diagnosed T2N0M0 glottic cancer were extracted from the Surveillance, Epidemiology, and End Results database. Survival analyses and Cox regression analyses were conducted to evaluate overall survival (OS) and cancer-specific survival (CSS). In consideration of competing events, the competing risk (CR) analysis was applied. Furthermore, propensity-score matching (PSM) was applied to mimic randomized-controlled trials and reduce selection bias.

Results

A total of 923 eligible patients met the inclusion criteria. Survival analyses showed that age, marital status, primary site surgery, and radiation were independent predictors of OS. Besides, age, marital status, primary site surgery, radiation, and chemotherapy were independent predictors of CSS. Cox regression analyses and the CR analysis were basically consistent with this result. In addition, an internal validation and PSM were performed to explore the role of chemotherapy.

Conclusion

We conducted a comprehensive analysis to prove that age, marital status, primary site surgery, radiation, and chemotherapy may be valuable prognostic risk factors for initially diagnosed T2N0M0 glottic cancer. Primary site surgery and radiation should be recommended, whereas chemotherapy was likely not suitable so far. Furthermore, we constructed a CR nomogram to predict survival rates.

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Abbreviations

OS:

Overall survival

CSS:

Cancer-specific survival

SEER:

Surveillance, epidemiology, and end results

KM:

Kaplan–Meier

CR:

Competing risk

PSM:

Propensity-score matching

AJCC:

American Joint Committee on Cancer

HR:

Hazard ratio

CI:

Confidence interval

CIF:

Cumulative incidence function

SHR:

Sub-distribution hazard ratio

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Acknowledgements

We are grateful to Dr. Hui-Zi Li for his technical support.

Funding

The work was supported by Grants from the National Natural Science Foundation of China (no. 81172561), the Ministry of Science and Technology of the People’s Republic of China (no. 2014CB541700), and Department of Science and Technology of Zhejiang Province (no. 2015C03035).

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Authors and Affiliations

  1. Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China

    Guan-Jiang Huang & Bei-Bei Yang

Authors
  1. Guan-Jiang Huang
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  2. Bei-Bei Yang
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Contributions

G-JH and B-BY performed the conception and design of this manuscript. G-JH and B-BY performed data analysis and prepared the figure. G-JH and B-BY drafted and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bei-Bei Yang.

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Conflict of interest

The authors declare no conflicts of interest in the work.

Ethical approval

Ethics approval and patient written informed consent were not required, because all analyses in our study were mainly performed based on data from the SEER database.

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Not applicable.

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Supplementary Information

Below is the link to the electronic supplementary material.

405_2020_6557_MOESM2_ESM.tif

Supplementary file1Multivariable analyses based on patients’ characteristics. A, Forest plot for the OS. Patients who were married or underwent primary site surgery or underwent radiation would have a better OS, whereas patients of age≥65 would suffer a worse OS. Chemotherapy (p=0.13) was not considered as an independent predictor of OS. B, Forest plot for the CSS. Patients who were married or underwent primary site surgery or underwent radiation would have a better CSS, whereas patients who were age≥65 or underwent chemotherapy would suffer a worse CSS. Abbreviations: OS, overall survival; CSS, cancer-specific survival (TIF 4609 KB)

405_2020_6557_MOESM3_ESM.tif

Supplementary file2Cumulative incidence of cancer-specific death and death of other causes on various factors (1, cancer-specific death; 2, death of other causes). A, Age. B, Sex. C, Race. D, Marital status. E, Grade. F, Year of diagnosis. G, Primary site surgery. H, Radiation. I, Chemotherapy (TIF 4639 KB)

405_2020_6557_MOESM4_ESM.tif

Supplementary file3Survival analyses of chemotherapy based on the training and the validation cohorts. A, Patients’ OS after chemotherapy in the training cohort. B, Patients’ CSS after chemotherapy in the training cohort. C, Patients’ OS after chemotherapy in the validation cohort. D, Patients’ CSS after chemotherapy in the validation cohort. Abbreviations: OS, overall survival; CSS, cancer-specific survival (TIF 3701 KB)

405_2020_6557_MOESM5_ESM.docx

Supplementary file4Survival analyses between chemotherapy (Yes) and chemotherapy (No/unknown) groups after PSM. A, Patients’ OS after chemotherapy. B, Patients’ CSS after chemotherapy. C, Patients’ OS after chemotherapy plus primary site surgery. D, Patients’ CSS after chemotherapy plus primary site surgery. E, Patients’ OS after chemotherapy plus radiation. F, Patients’ CSS after chemotherapy plus radiation. G, Patients’ OS after chemotherapy plus primary site surgery and radiation. H, Patients’ CSS after chemotherapy plus primary site surgery and radiation. Abbreviations: OS, overall survival; CSS, cancer-specific survival; PSM, propensity-score matching (TIF 9348 KB)

Supplementary file5 (DOCX 15 KB)

Supplementary file6 (TIFF 4605 KB)

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Huang, GJ., Yang, BB. Prognostic risk factors for initially diagnosed T2N0M0 glottic cancer: competing risk analysis and propensity-score matched cohort analysis. Eur Arch Otorhinolaryngol 278, 3921–3931 (2021). https://doi.org/10.1007/s00405-020-06557-9

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