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Competing risk models versus traditional Cox models for prognostic factors’ prediction and care recommendation in patients with advanced laryngeal squamous carcinoma: a population-based study

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To explore the prognostic factors and the optimal treatment modalities for patients with stage IVA laryngeal squamous cell carcinoma (LSCC), so as to improve the survival rate of patients.

Methods

Patients with stage IVA LSCC between 2004 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. We used competing risk models to build nomograms for predicting cancer-specific survival (CSS). The effectiveness of the model was assessed using the calibration curves and the concordance index (C-index). The above results were compared with the nomogram established by Cox regression analysis. The patients were grouped into low-risk and high-risk groups by competing risk nomogram formula. And the Kaplan–Meier (K–M) method and log-rank test were used to make sure that these groups had a survival difference.

Results

Overall, 3612 patients were included. Older age, black race, a higher N stage, a higher pathological grade, and a larger tumor size were independent risk factors for CSS; married marital status, total/radical laryngectomy, and radiotherapy were protective factors. The C-index was 0.663, 0.633, and 0.628 in the train set and 0.674, 0.639, and 0.629 in the test set of the competing risk model, and 0.672, 0.640, and 0.634 in the traditional Cox nomogram for 1, 3, and 5 years. In overall survival and CSS, the prognosis of the high-risk group was poorer than that of the low-risk group.

Conclusion

For patients with stage IVA LSCC, a competing risk nomogram was created to help screen risk population and guide clinical decision-making.

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Data availability

The raw data were derived from Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Software version 8.4.0.1. https://seer.cancer.gov/seerstat/download. Accessed June 11, 2022.

Abbreviations

CIF:

Cumulative incidence function

C-index:

Concordance index

CRT:

Chemoradiotherapy

CSS:

Cancer-specific survival

K–M:

Kaplan–Meier

LSCC:

Laryngeal squamous cell carcinoma

NCCN:

National Comprehensive Cancer Network

OS:

Overall survival

SEER:

Surveillance, Epidemiology, and End Results

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Acknowledgements

The authors are grateful to the open access SEER database and R software for providing us with the raw research data and for the data analysis, and to all the professors and friends who have helped us with the use of related software.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Zhuo Song and Zewen Chen have contributed equally to this study.

Authors and Affiliations

  1. Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China

    Zhuo Song & Lijuan Zou

  2. Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China

    Zewen Chen & Xiuzhen Sun

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  1. Zhuo Song
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Contributions

Conceptualization: ZS, ZC, XS, and LZ; data curation: ZS and ZC; formal analysis: ZS and ZC; writing—original draft preparation: ZS and ZC; writing—review and editing: ZS, ZC, XS, and LZ. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Xiuzhen Sun or Lijuan Zou.

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Ethical review and approval were waived for this study, due to the data being publicly available and anonymous.

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405_2023_7983_MOESM1_ESM.tif

Supplementary Figure 1. Traditional Cox nomogram to predict 1-, 3-, and 5-year cancer specific survival (CSS) in patients with primary stage IVA laryngeal squamous cell carcinoma

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Song, Z., Chen, Z., Sun, X. et al. Competing risk models versus traditional Cox models for prognostic factors’ prediction and care recommendation in patients with advanced laryngeal squamous carcinoma: a population-based study. Eur Arch Otorhinolaryngol 280, 3745–3756 (2023). https://doi.org/10.1007/s00405-023-07983-1

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