Prognostic prediction model for patients with head and neck squamous cell carcinoma based on the SEER database_Chinese Journal of Evidence-Based Medicine

Authors：

XIE Hongyu , ZHAO Lin , KANG Lunwei ,  LIAO Ga

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LIAO Ga, Email: liaoga@hotmail.com

Keywords：

Head and neck squam ous cell carcinoma (HNSCC); Nomogram; Overall survival; Prognostic model; Risk stratification

DOI：

10.7507/1672-2531.202412008

Video：

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Objective This study aimed to identify independent risk factors for head and neck squamous cell carcinoma (HNSCC) based on the surveillance, epidemiology, and end results (SEER) database and to develop a nomogram model for predicting patient survival outcomes. Methods Patients diagnosed with HNSCC from 1975 to 2021 were selected from the SEER database. After applying inclusion and exclusion criteria, 2 271 patients were included and randomly divided into a training cohort and a validation cohort in a 7:3 ratio. Independent prognostic factors were identified using LASSO regression, Cox regression analysis, and the Akaike information criterion (AIC). A nomogram model was constructed, and its discrimination and calibration were assessed using the concordance index (C-index), time-dependent area under the curve (time-dependent AUC), and calibration curves. The nomogram model was compared with the American Joint Committee on Cancer (AJCC) staging system using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI) to evaluate clinical utility and risk stratification performance. Results Five independent prognostic factors (age, marital status, N stage, tumor stage, and radiotherapy) were selected to build the nomogram model for HNSCC. The C-index values of the model were 0.731 4 (95%CI 0.714 5 to 0.748 5) in the training cohort and 0.735 1 (95%CI 0.709 1 to 0.761 0) in the validation cohort. The time-dependent AUC values were all above 0.7, indicating good discriminatory ability. Moreover, decision curve analysis showed that the nomogram model provided higher clinical net benefits at different threshold probabilities and performed better than the AJCC staging system in identifying high-risk patients. Conclusion This study develops a nomogram model based on the SEER database to predict survival outcomes in patients with HNSCC. The model demonstrates high discrimination and clinical utility, offering a personalized prognostic tool for clinicians.

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16.	Qi CL, Sheng JF, Huang ML, et al. Integrated analysis of deregulation microRNA expression in head and neck squamous cell carcinoma. Medicine (Baltimore), 2021, 100(6): e24618.
17.	Lassen P, Eriksen JG, Krogdahl A, et al. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial. Radiother Oncol, 2011, 100(1): 49-55.
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19.	Rygalski CJ, Zhao S, Eskander A, et al. Time to surgery and survival in head and neck cancer. Ann Surg Oncol, 2021, 28(2): 877-885.

1. Johnson DE, Burtness B, Leemans CR, et al. Head and neck squamous cell carcinoma. Nat Rev Dis Primers, 2020, 6(1): 92.
2. Fouad H, Commar A, Hamadeh R, et al. Estimated and projected prevalence of tobacco smoking in males, Eastern Mediterranean Region, 2000-2025. East Mediterr Health J, 2021, 27(1): 76-82.
3. Choi SE, Choudhary A, Huang J, et al. Increasing HPV vaccination coverage to prevent oropharyngeal cancer: a cost-effectiveness analysis. Tumour Virus Res, 2022, 13: 200234.
4. Ferlay J. Global cancer observatory: cancer today Vol 419. Lyon, France: International Agency for Research on Cancer, 2020.
5. Huang SH, O'Sullivan B. Overview of the 8th edition TNM classification for head and neck cancer. Curr Treat Options Oncol, 2017, 18(7): 40.
6. Iasonos A, Schrag D, Raj GV, et al. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008, 26(8): 1364-1370.
7. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
8. Pencina MJ, D'Agostino RB, Steyerberg EW. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med, 2011, 30(1): 11-21.
9. Uno H, Tian L, Cai T, et al. A unified inference procedure for a class of measures to assess improvement in risk prediction systems with survival data. Stat Med, 2013, 32(14): 2430-2442.
10. Fitzgerald M, Saville BR, Lewis RJ. Decision curve analysis. JAMA. 2015, 313(4): 409-410.
11. Chang JH, Wu CC, Yuan KS, et al. Locoregionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors, and treatment outcomes. Oncotarget, 2017, 8(33): 55600-55612.
12. van der Kamp MF, Halmos GB, Guryev V, et al. Age-specific oncogenic pathways in head and neck squamous cell carcinoma - are elderly a different subcategory. Cell Oncol (Dordr), 2022, 45(1): 1-18.
13. Osazuwa-Peters N, Adjei Boakye E, Chen BY, et al. Association between head and neck squamous cell carcinoma survival, smoking at diagnosis, and marital status. JAMA Otolaryngol Head Neck Surg, 2018, 144(1): 43-50.
14. Tezal M, Sullivan MA, Hyland A, et al. Chronic periodontitis and the incidence of head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev, 2009, 18(9): 2406-2412.
15. Chan JYK, Cheung MK, Lan L, et al. Characterization of oral microbiota in HPV and non-HPV head and neck squamous cell carcinoma and its association with patient outcomes. Oral Oncol, 2022, 135: 106245.
16. Qi CL, Sheng JF, Huang ML, et al. Integrated analysis of deregulation microRNA expression in head and neck squamous cell carcinoma. Medicine (Baltimore), 2021, 100(6): e24618.
17. Lassen P, Eriksen JG, Krogdahl A, et al. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial. Radiother Oncol, 2011, 100(1): 49-55.
18. Rühle A, Marschner S, Haderlein M, et al. Evaluation of concomitant systemic treatment in older adults with head and neck squamous cell carcinoma undergoing definitive radiotherapy. JAMA Netw Open, 2023, 6(2): e230090.
19. Rygalski CJ, Zhao S, Eskander A, et al. Time to surgery and survival in head and neck cancer. Ann Surg Oncol, 2021, 28(2): 877-885.

Chinese Journal of Evidence-Based Medicine

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