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).
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.
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).
The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.
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Supported by Grants No. U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology Statistics and Data Management Center), and U10CA37422 (Community Clinical Oncology Program) from the National Cancer Institute and Eli Lilly Oral Cancer Foundation.
Supplements: https://doi.org/10.1200/JCO. 2016.72.0748
Disclosures provided by the authors are available with this article at jco.org.
Fakhry, Carol; Zhang, Qiang; Nguyen-Tân, Phuc Felix; Rosenthal, David I.; Weber, Randal S.; Lambert, Louise; Trotti, Andy M. III; Barrett, William L.; Thorstad, Wade L.; Jones, Christopher U.; Yom, Sue S.; Wong, Stuart J.; Ridge, John A.; Rao, Shyam S. D.; Bonner, James A.; Vigneault, Eric; Raben, David; Kudrimoti, Mahesh R.; Harris, Jonathan; Le, Quynh-Thu; and Gillison, Maura L., "Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer" (2017). Radiation Medicine Faculty Publications. 10.