Nomogram-Based Prediction of Overall and Disease-Specific Survival in Patients With Postoperative Major Salivary Gland Squamous Cell Carcinoma

Abstract

Background : The major salivary gland squamous cell carcinoma is a rare head and neck tumor, often accompanied by lymph node metastasis. Even if the patient undergoes surgery, the prognosis remains unsatisfactory. To explore the prognostic factors of postoperative major salivary gland squamous cell carcinoma to establish a prognostic risk stratification model to guide clinical practice. Methods: Patients' information was retrieved from the Surveillance, Epidemiology, and End Results database from 2004 to 2018. Optimal cutoff points were determined using X-tile software, and overall survival and disease-specific survival were calculated by the Kaplan-Meier method. Independent prognostic factors affecting the overall survival and disease-specific survival were identified by multivariate analysis, and corresponding 2 nomogram models were constructed. The discriminative ability and calibration of nomograms were evaluated by the Concordance index, area under curves, and calibration plots. Results: A total of 815 patients with postoperative major salivary gland squamous cell carcinoma were enrolled. The cutoff values for the number of lymph nodes were 2, and the cutoff values for the lymph node ratio were 0.11 and 0.5, respectively. Age, T stage, tumor size, lymph nodes, lymph node ratio, and radiotherapy were prognostic factors for overall survival and disease-specific survival. Nomograms for disease-specific survival and overall survival were established and showed favorable performance with a higher Concordance index and area under curves than that of the tumor-node-metastasis stage and Surveillance, Epidemiology, and End Results stage. The calibration plots of 1-, 3-, and 5-year overall survival and disease-specific survival also exhibited good consistency. What's more, patients were divided into low-, moderate-, and high-risk groups according to the scores calculated by the models. The overall survival and disease-specific survival of patients in the high-risk group were significantly worse than those in the moderate- and low-risk group. Conclusions: Our nomogram integrated clinicopathological features and treatment modality to demonstrate excellent performance in risk stratification and prediction of survival outcomes in patients with major salivary gland squamous cell carcinoma after surgery, with important clinical value.

Keywords: lymph node number; lymph node ratio; major salivary glands cancer; nomogram; squamous cell carcinoma.

Figure 1.

Nomogram model of OS (A) and DSS (B) in patients with MSSCC after surgery. Abbreviations: OS, overall survival; DSS, disease-specific survival; MSSCC, squamous cell carcinoma of the major salivary gland.

Figure 2.

The ROC curve for 1-, 3-, and 5-year OS and DSS. (A-C) Comparison of the ROC curves of the nomogram, the TNM stage, SEER stage for 1-year OS (A), 3-year OS (B), and 5-year OS (C). D-F. Comparison of the ROC curves of the nomogram, the TNM stage, SEER stage for 1-year DSS (D), 3-year DSS (E), and 5-year DSS (F). Abbreviations: OS, overall survival; DSS, disease-specific survival; ROC, receiver operator characteristic; TNM, tumor–node–metastasis; SEER, Surveillance, Epidemiology, and End Results.

Figure 3.

The calibration plots for 1-, 3-, and 5-year OS and DSS. (A) 1-year calibration plot for OS nomogram; (B) 3-year calibration plot for OS nomogram; (C) 5-year calibration plot for OS nomogram; (D) 1-year calibration plot for DSS nomogram; (E) 3-year calibration plot for DSS nomogram; (F) 5-year calibration plot for DSS nomogram. Abbreviations: OS, overall survival; DSS, disease-specific survival.

Figure 4.

The OS (A) and DSS (B) of patients among the low-, moderate-, and high-risk groups. Abbreviations: OS, overall survival; DSS, disease-specific survival.