Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Cancer. 2014 Jan 15;120(2):214-21. doi: 10.1002/cncr.28407. Epub 2013 Oct 25.
This study sought to develop prognostic tools that will accurately predict overall and cancer-related mortality and risk of recurrence in individual patients with oral cancer based on host and tumor characteristics. These tools would take into account numerous prognosticators beyond those covered by the traditional TNM (tumor-node-metastasis) staging system.
Demographic, host, and tumor characteristics of 1617 patients with cancer of the oral cavity, who were treated primarily with surgery at a single-institution tertiary care cancer center between 1985 and 2009, were reviewed from a preexisting database. Recurrent disease was recorded in 509 patients (456 locoregional and 116 distant); 328 patients died of cancer-related causes, and 542 died of other causes. The median follow-up was 42 months (range, 1-300 months). The following variables were analyzed as predictors of prognosis: age, sex, race, alcohol and tobacco use, oral cavity subsite, invasion of other structures, comorbidity, tumor size, and clinical nodal status. The stepdown method was used to select the statistically most influential predictors for inclusion in the final nomogram for each outcome of interest.
The most influential predictors of both recurrence and cancer-specific mortality probability (CSMP) were tumor size, nodal status, subsite, and bone invasion. Nomograms were generated for prediction of overall survival (OS), CSMP, and locoregional recurrence-free probability (LRRFP). The nomograms were internally validated with an overfit-corrected predictive discrimination metric (concordance index) for OS of 67%, CSMP of 66%, and LRRFP of 60%.
Nomograms have been developed that can reasonably estimate OS, CSMP, and LRRFP based on specific tumor and host characteristics in patients with oral cancer.
本研究旨在开发预测工具，根据宿主和肿瘤特征，准确预测个体口腔癌患者的总生存率和癌症相关死亡率以及复发风险。这些工具将考虑到传统 TNM（肿瘤-淋巴结-转移）分期系统涵盖的众多预后因素以外的因素。
回顾性分析 1985 年至 2009 年间在单一机构三级癌症中心接受主要手术治疗的 1617 例口腔癌患者的人口统计学、宿主和肿瘤特征。509 例患者（456 例局部区域复发和 116 例远处转移）记录到复发病例；328 例患者死于癌症相关原因，542 例患者死于其他原因。中位随访时间为 42 个月（范围 1-300 个月）。分析以下变量作为预后预测因素：年龄、性别、种族、饮酒和吸烟、口腔部位、侵犯其他结构、合并症、肿瘤大小和临床淋巴结状态。采用逐步回归法选择对每个感兴趣结局具有统计学意义的最具影响力的预测因素，纳入最终列线图。
肿瘤大小、淋巴结状态、部位和骨侵犯是预测复发和癌症特异性死亡率（CSMP）的最主要影响因素。生成了预测总生存率（OS）、CSMP 和局部区域无复发生存率（LRRFP）的列线图。通过过度拟合校正预测区分度指标（一致性指数）对 OS、CSMP 和 LRRFP 进行内部验证，一致性指数分别为 67%、66%和 60%。
已开发出列线图，可以根据口腔癌患者的特定肿瘤和宿主特征合理估计 OS、CSMP 和 LRRFP。
