Nomograms to estimate long-term overall survival and tongue cancer-specific survival of patients with tongue squamous cell carcinoma

Abstract

The aim of this study was to construct nomograms to predict long-term overall survival (OS) and tongue cancer-specific survival (TCSS) of tongue squamous cell carcinoma (TSCC) patients based on clinical and tumor characteristics. Clinical, tumor, and treatment characteristics of 12,674 patients diagnosed with TSCC between 2004 and 2013 were collected from the Surveillance, Epidemiology, and End Results database. These patients were then divided into surgery and nonsurgery cohorts, and nomograms were developed for each of these groups. The step-down method and cumulative incidence function were used for model selection to determine the significant prognostic factors associated with OS and TCSS. These prognostic variables were incorporated into nomograms. An external cohort was used to validate the surgery nomograms. Seven variables were used to create the surgery nomograms for OS and TCSS, which had c-indexes of 0.709 and 0.728, respectively; for the external validation cohort, the c-indexes were 0.691 and 0.711, respectively. Nine variables were used to create the nonsurgery nomograms for OS and TCSS, which had c-indexes of 0.750 and 0.754, respectively. The calibration curves of the 5- and 8-year surgery and nonsurgery nomograms showed excellent agreement between the probabilities and observed values. By incorporating clinicopathological and host characteristics in patients, we are the first to establish nomograms that accurately predict prognosis for individual patients with TSCC. These nomograms ought to provide more personalized and reliable prognostic information, and improve clinical decision-making for TSCC patients.

Keywords: Head and neck; nomogram; overall survival; tongue cancer-specific survival; tongue squamous cell carcinoma.

Figure 1

Flowchart for the Surveillance, Epidemiology, and End Results data selection.

Figure 2

Nomogram for predicting 5‐ and 8‐year (A) overall survival (OS) and (B) tongue cancer‐specific survival (TCSS) in tongue squamous cell carcinoma (TSCC) patients with surgical treatment. The nomogram is used by summing up the points identified on the points scale for each characteristic of the patient. This total point score is then identified at the bottom scale to determine the probability of 5‐ and 8‐year OS or TCSS for an individual patient. Grade: I, Well differentiated; II, Moderately differentiated; III, Poorly differentiated; IV, undifferentiated. Marital: M, married; U, unmarried. Race: Other, American Indian/AK Native, Asian/Pacific Islander.

Figure 3

Nomogram for predicting 5‐ and 8‐year (A) overall survival (OS) and (B) tongue cancer‐specific survival (TCSS) in tongue squamous cell carcinoma (TSCC) patients with nonsurgical treatment. The nomogram is used by summing up the points identified on the points scale for each characteristic of the patient. This total point score is then identified at the bottom scale to determine the probability of 5‐ and 8‐year OS or TCSS for an individual patient. Grade: I, Well differentiated; II, Moderately differentiated; III, Poorly differentiated; IV, undifferentiated. Marital: M, married; U, unmarried. Race: Other, American Indian/AK Native, Asian/Pacific Islander.

Figure 4

External calibration of the surgery nomogram. (A) 5‐year and (C) 8‐year overall survival nomogram calibration curves; (B) 5‐year and (D) 8‐year tongue cancer‐specific survival nomogram calibration curves. The X–axis represents the nomogram–predicted survival, and the actual survival is plotted on the Y–axis. The dotted line represents the ideal match between predicted and actual survival. Vertical bars indicate 95% confidence intervals.