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A novel nomogram and risk classification system for predicting overall survival in head and neck squamous cell cancer with distant metastasis at initial diagnosis

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Abstract

Introduction

Head and neck squamous cell carcinoma (HNSCC) is one of the most invasive cancer types globally, and distant metastasis (DM) is associated with a poor prognosis. The objective of this study was designed to construct a novel nomogram and risk classification system to predict overall survival (OS) in HNSCC patients presenting with DM at initial diagnosis.

Methods

HNSCC patients with initially diagnosed DM between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Firstly, all patients were randomly assigned to a training cohort and validation cohort (8:2), respectively. The Cox proportional hazards regression model was used to analyze the prognostic factors associated with OS. Then, the nomogram based on the prognostic factors and the predictive ability of the nomogram were assessed by the calibration curves, receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Finally, a risk classification system was established according to the nomogram scores.

Results

A total of 1240 patients initially diagnosed with HNSCC with DM were included, and the 6-, 12- and 18-month OS of HNSCC with DM were 62.7%, 40.8% and 30%, respectively. The independent prognostic factors for HNSCC patients with DM included age, marital status, primary site, T stage, N stage, bone metastasis, brain metastasis, liver metastasis, lung metastasis, surgery, radiotherapy and chemotherapy. Based on the independent prognostic factors, a nomogram was constructed to predict OS in HNSCC patients with DM. The C-index values of the nomogram were 0.713 in the training cohort and 0.674 in the validation cohort, respectively. The calibration curves and DCA also indicated the good predictability of the nomogram. Finally, a risk classification system was built and it revealed a statistically significant difference among the three groups of patients according to the nomogram scores.

Conclusions

Factors associated with the overall survival of HNSCC patients with DM were found. According to the identified factors, we generated a nomogram and risk classification system to predict the OS of patients with initially diagnosed HNSCC with DM. The prognostic nomogram and risk classification system can help to assess survival time and provide guidance when making treatment decisions for HNSCC patients with DM.

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Availability of data and materials

The dataset from SEER database generated and/or analyzed during the current study are available in the SEER dataset repository (https://seer.cancer.gov/).

Abbreviations

HNSCC:

Head and neck squamous cell carcinoma

DM:

Distant metastasis

OS:

Overall survival

SEER:

Surveillance epidemiology and end results

AJCC:

American Joint Committee on Cancer

ROC:

Receiver operating characteristic

AUC:

Area under the curve

DCA:

Decision curve analysis

HR:

Ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People’s Republic of China

    Run-Qiu Zhu, Ya-Min Zhang, Xia-Yan Luo, Wen-Yi Shen & Hui-Yong Zhu

  2. Zhejiang University School of Medicine, Hangzhou, China

    Run-Qiu Zhu, Ya-Min Zhang, Xia-Yan Luo & Wen-Yi Shen

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Contributions

Study design: R-QZ, Y-MZ, and H-YZ. Data collection: W-YS and X-YL. Manuscript preparation: R-QZ, Y-MZ. Data analysis and interpretation: R-QZ and W-YS. H-YZ participated in the design of the study and drafted the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Hui-Yong Zhu.

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Zhu, RQ., Zhang, YM., Luo, XY. et al. A novel nomogram and risk classification system for predicting overall survival in head and neck squamous cell cancer with distant metastasis at initial diagnosis. Eur Arch Otorhinolaryngol 280, 1467–1478 (2023). https://doi.org/10.1007/s00405-022-07716-w

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