Nomogram based on clinical characteristics and serological inflammation markers to predict overall survival of oral tongue squamous cell carcinoma patient after surgery

Abstract

Background: Oral tongue squamous cell carcinoma (OTSCC) is a prevalent malignant disease that is characterized by high rates of metastasis and postoperative recurrence. The aim of this study was to establish a nomogram to predict the outcome of OTSCC patients after surgery.

Methods: We retrospectively analyzed 169 OTSCC patients who underwent treatments in the Cancer Hospital of Shantou University Medical College from 2008 to 2019. The Cox regression analysis was performed to determine the independent prognostic factors associated with patient's overall survival (OS). A nomogram based on these prognostic factors was established and internally validated using a bootstrap resampling method.

Results: Multivariate Cox regression analysis revealed the independent prognostic factors for OS were TNM stage, age, lymphocyte-to-monocyte ratio and immunoglobulin G, all of which were identified to create the nomogram. The Akaike Information Criterion and Bayesian Information Criterion of the nomogram were lower than those of TNM stage (292.222 vs. 305.480; 298.444 vs. 307.036, respectively), indicating a better goodness-of-fit of the nomogram for predicting OS. The bootstrap-corrected of concordance index (C-index) of nomogram was 0.784 (95% CI 0.708-0.860), which was higher than that of TNM stage (0.685, 95% CI 0.603-0.767, P = 0.017). The results of time-dependent C-index for OS also showed that the nomogram had a better discriminative ability than that of TNM stage. The calibration curves of the nomogram showed good consistency between the probabilities and observed values. The decision curve analysis also revealed the potential clinical usefulness of the nomogram. Based on the cutoff value obtained from the nomogram, the proposed high-risk group had poorer OS than low-risk group (P < 0.0001).

Conclusions: The nomogram based on clinical characteristics and serological inflammation markers might be useful for outcome prediction of OTSCC patient.

Keywords: Inflammation markers; Oral tongue squamous cell carcinoma; Pretreatment nomogram; Prognosis; Surgery.

Fig. 1

The flowchart for selection procedure of oral tongue squamous cell carcinoma patients

Fig. 2

The HR and 95% CI of four independent prognostic factors for OS. TNM, tumor/node/metastasis; LMR, lymphocyte-to-monocyte ratio; IgG, immunoglobulin G; HR, hazard ratio; 95% CI, 95% confidence interval; OS, overall survival

Fig. 3

Nomogram based on TNM stage, age, LMR and IgG in prediction for 1-, 3- and 5-year OS of OTSCC patient. The nomogram was used by summing the points identified on the points scale for each prognostic factor. The total points projected on the bottom scales match the probability of 1-, 3-, and 5-year survival of patient. OS, overall survival; LMR, lymphocyte-to-monocyte ratio; IgG, immunoglobulin G; OTSCC, oral tongue squamous cell carcinoma; TNM, tumor/node/metastasis

Fig. 4

Time-dependent C-index of nomogram compared with TNM stage, age, LMR and IgG for OS of OTSCC patient (a) and internally validated with using a bootstrap resampling method (b). C-index, concordance index; OS, overall survival; LMR, lymphocyte-to-monocyte ratio; IgG, immunoglobulin G; OTSCC, oral tongue squamous cell carcinoma; TNM, tumor/node/metastasis

Fig. 5

Decision curve analysis of nomogram compared with TNM stage, age, LMR and IgG for 1-year OS (a), 3-year OS (b), 5-year OS (c) of OTSCC patient. The thick grey line is the net benefit for a strategy of treating all men; the thick black line is the net benefit of treating no men. The y-axis indicates the overall net benefit, which is calculated by summing the benefits (true positive results) and subtracting the harms (false positive results). OS, overall survival; LMR, lymphocyte-to-monocyte ratio; IgG, immunoglobulin G; OTSCC, oral tongue squamous cell carcinoma; TNM, tumor/node/metastasis

Fig. 6

Calibration curves for 1-year OS (a), 3-year OS (b), 5-year OS (c) of nomogram predictions. OS, overall survival

Fig. 7

Kaplan-Meier curve for OS based on the prediction of nomogram. Low risk, Total points < 195.13 for OS; High risk, Total points ≥ 195.13 for OS. OS, overall survival