Nomogram based on albumin and neutrophil-to-lymphocyte ratio for predicting the prognosis of patients with oral cavity squamous cell carcinoma

Abstract

Increasing evidence indicates that inflammation plays a crucial role in cancer development. A novel scoring system based on albumin and the neutrophil-to-lymphocyte ratio (NLR) was developed and incorporated into a nomogram to create a more accurate prognostic tool for oral cavity squamous cell carcinoma (OSCC) patients. A retrospective review was performed on 613 consecutive patients undergoing ablative surgery for OSCC between September 2005 and December 2014. NLR and albumin were determined and used to calculate an albumin/NLR score (ANS). The nomogram was based on the ANS and several clinicopathological manifestations, and its accuracy was determined by the concordance index (c-index). A high ANS was significantly associated with aggressive tumor behaviors, such as T status, overall stage, extranodal extension, perineural invasion, tumor depth, and decreased overall survival (OS). Multivariate analysis indicated that age, overall stage, extranodal extension, and ANS were independent factors for OS. The c-index for OS prognosis was 0.750 using this nomogram compared to 0.688 using TNM staging alone. The prognostic accuracy for OS in OSCC patients can be significantly improved using a nomogram that incorporates the novel ANS and other clinicopathological variables.

Figure 1

Association of albumin, NLR and ANS with the probability of overall survival (OS). (a) Kaplan-Meier plot for OS probability, where the 5-year OS rates for patient subgroups stratified by albumin were 77.6% vs. 58.0% (p < 0.0001). (b) Kaplan-Meier plot for OS probability, where the 5-year OS rates for patient subgroups stratified by NLR were 75.2% vs. 60.7% (p < 0.0001). (c) Kaplan-Meier plot for OS probability, where the 5-year OS rates for patient subgroups stratified by ANS score were 81.6% vs. 69.2% vs. 52.0% (p < 0.0001).

Figure 2

Nomogram and survival predictions. (a) Nomogram for OS prediction. A vertical line is drawn from each factor to the point score. By adding the points from all factors, a total points score is reached, which is translated into 3-year and 5-year OS probabilities by drawing a vertical line to its axis. Calibration plots of the nomogram to predict (b) 3-year OS and (c) 5-year OS. The blue line indicates the ideal prediction, and the black line represents the nomogram’s performance. Black dots with bars represent the nomogram’s performance with 95% CI when applied to the observed surviving cohorts. Abbreviations: ENE = extranodal extension; ANS = albumin/NLR score.