Raab Gabriel, Yu Yao, Sherman Eric, Wong Richard, Mell Loren K, Lee Nancy Y, Zakeri Kaveh
Weill Cornell Medical College, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Clin Transl Radiat Oncol. 2024 Jan 13;45:100725. doi: 10.1016/j.ctro.2024.100725. eCollection 2024 Mar.
PURPOSE/OBJECTIVES: We sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death.
We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings.
Among 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4-3.7 %) and 2.2 %, (95 % CI 1.9-2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3-8.2 %) in the definitive group and 4.4 % (95 % CI 3.6-5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61).
Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.
目的/目标：我们试图创建列线图以预测早期死亡的个体风险，该列线图能够识别需要采取干预措施以预防早期死亡的患者。
我们纳入了国家癌症数据库中2004年至2017年间在根治性或辅助性治疗中接受放疗和全身治疗的非转移性头颈部鳞状细胞癌患者。早期死亡定义为开始放疗后90天内的任何死亡。采用多变量逻辑回归评估协变量与早期死亡之间的关系。为根治性和辅助性治疗设置分别创建了预测早期死亡风险的列线图。
在根治性治疗组的84,563例患者和辅助性治疗组的18,514例患者中，早期死亡率分别为3.5%（95%CI 3.4 - 3.7%）和2.2%（95%CI 1.9 - 2.4%）。70岁以上患者在根治性治疗组的早期死亡率为7.8%（95%CI 7.3 - 8.2%），在辅助性治疗组为4.4%（95%CI 3.6 - 5.4%）。在多变量分析中，年龄、合并症、T和N分期以及肿瘤部位在两个队列中均与早期死亡相关（所有p值均<0.05）。包含年龄、合并症、T和N分期以及肿瘤部位的列线图在预测早期死亡方面比单独使用年龄表现更好（根治性治疗组AUC：0.70对0.66；辅助性治疗组AUC：0.71对0.61）。
开发了包含年龄、合并症、T和N分期以及肿瘤部位的列线图，以预测根治性或辅助性放化疗后的早期死亡风险。
