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. 2020 Sep;130(9):2166-2172.
doi: 10.1002/lary.28345. Epub 2019 Nov 6.

Optimizing Survival Predictions of Hypopharynx Cancer: Development of a Clinical Prediction Model

Coralie R Arends  1 , Japke F Petersen  1 , Vincent van der Noort  2 , Adriana J Timmermans  1   3 , C René Leemans  3 , Remco de Bree  4 , Michiel W M van den Brekel  1   5   6 , Martijn M Stuiver  1   7
Affiliations

Optimizing Survival Predictions of Hypopharynx Cancer: Development of a Clinical Prediction Model

Coralie R Arends et al. Laryngoscope. 2020 Sep.

Abstract

Objectives: To develop and validate a clinical prediction model (CPM) for survival in hypopharynx cancer, thereby aiming to improve individualized estimations of survival.

Methods: Retrospective cohort study of hypopharynx cancer patients. We randomly split the cohort into a derivation and validation dataset. The model was fitted on the derivation dataset and validated on the validation dataset. We used a Cox's proportional hazard model and least absolute shrinkage and selection operator (LASSO) selection. Performance (discrimination and calibration) of the CPM was tested.

Results: The final model consisted of gender, subsite, TNM classification, Adult Comorbidity Evaluation-27 score (ACE27), body mass index (BMI), hemoglobin, albumin, and leukocyte count. Of these, TNM classification, ACE27, BMI, hemoglobin, and albumin had independent significant associations with survival. The C Statistic was 0.62 after validation. The model could significantly identify clinical risk groups.

Conclusions: ACE27, BMI, hemoglobin, and albumin are independent predictors of overall survival. The identification of high-risk patients can be used in the counseling process and tailoring of treatment strategy or follow-up.

Level of evidence: 4 Laryngoscope, 130:2166-2172, 2020.

Keywords: Hypopharynx cancer; LASSO; chemoradiotherapy; clinical prediction model; survival; total laryngectomy.

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Figures

Figure 1
Figure 1
Inclusion of patients [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
Figure 2
Figure 2
Nomogram of the final model. Combining the amount of points that correspond with each variable on the top scale will lead to a total amount of points. If a patient has less than 154 points on this nomogram, he can be considered low risk, between 155 and 201 medium risk, and above 202 points he can be considered as a patient with a high risk of death.
Figure 3
Figure 3
Calibration plot of the CPM model after validation. A 45‐degree line (dashed line) indicates perfect agreement between predicted and observed outcome.19 Calibration of our model is depicted in the straight line, and closely follows the 45‐degree line.
Figure 4
Figure 4
Kaplan Meier curves for three risk groups based on the derivation dataset. The Kaplan Meier curve of the derivation dataset is plotted using the straight line, and the validation dataset with the dashed line. Blue represents low risk, black medium risk, and red represents high risk of death. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
See this image and copyright information in PMC

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