Ma Yuchao, Liu Yang, Shayan Gulidanna, Yi Junlin, Wang Jingbo
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Transl Oncol. 2022 Jun;20:101401. doi: 10.1016/j.tranon.2022.101401. Epub 2022 Mar 23.
Lymph node ratio (LNR) has been increasingly reported as a prognostic factor in oral cavity squamous cell carcinoma (OCSCC). This study aimed to develop and validate a prognostic nomogram integrating LNR and to further assess its role in guiding adjuvant therapy for OCSCC.
A total of 8703 OCSCC patients treated primarily with surgery in the Surveillance, Epidemiology and End Results (SEER) database were retrieved and randomly divided into training and validation cohorts. The nomogram was created based on the factors identified by Cox model. The value of PORT and chemotherapy was respectively evaluated in each prognostic group according to nomogram-deduced individualized score.
The final nomogram included tumor site, grade, T stage, number of positive lymph nodes and LNR. Calibration plots demonstrated a good match between predicted and observed rates of overall survival (OS). The concordance indexes for training and validation cohorts were 0.720 (95% confidence interval (CI): 0.708, 0.732) and 0.711 (95% CI: 0.687, 0.735), both significantly higher than did TNM stage (p< 0.001). According to individualized nomogram score, patients were stratified into three subgroups with significantly distinct outcome. PORT presented survival benefit among medium- and high-risk groups whereas a near-detrimental effect in low-risk group. Chemotherapy was found to be beneficial only in high-risk group.
This LNR-incorporated nomogram surpassed the conventional TNM stage in predicting prognosis of patients with non-metastatic OCSCC and identified sub-settings that could gain survival benefit from adjuvant thearpy.
淋巴结比率（LNR）作为口腔鳞状细胞癌（OCSCC）的预后因素，其报道日益增多。本研究旨在开发并验证一个整合LNR的预后列线图，并进一步评估其在指导OCSCC辅助治疗中的作用。
在监测、流行病学和最终结果（SEER）数据库中检索了总共8703例主要接受手术治疗的OCSCC患者，并将其随机分为训练队列和验证队列。根据Cox模型确定的因素创建列线图。根据列线图推导的个体化评分，分别评估每个预后组中术后放疗（PORT）和化疗的价值。
最终的列线图包括肿瘤部位、分级、T分期、阳性淋巴结数量和LNR。校准图显示总生存率（OS）的预测值与观察值之间匹配良好。训练队列和验证队列的一致性指数分别为0.720（95%置信区间（CI）：0.708，0.732）和0.711（95%CI：0.687，0.735），均显著高于TNM分期（p<0.001）。根据个体化列线图评分，患者被分为三个亚组，其结局有显著差异。PORT在中高危组中显示出生存获益，而在低危组中显示出近乎有害的影响。发现化疗仅在高危组中有益。
这个纳入LNR的列线图在预测非转移性OCSCC患者的预后方面优于传统的TNM分期，并确定了可从辅助治疗中获得生存获益的亚组。
