Lin Dandan, Li Huling, Feng Xing, Zhang Yang, Tang Dandan, Wang Kai
School of Public Health, Xinjiang Medical University, Urumqi, China.
College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China.
World J Surg Oncol. 2025 Jul 25;23(1):302. doi: 10.1186/s12957-025-03883-2.
To develop a nomogram for predicting overall survival (OS) and cancer-specific survival (CSS) in patients with postoperative early-stage (pT1-2N0M0) tongue squamous cell carcinoma (TSCC), and to explore the association between postoperative radiotherapy (PORT) and patient survival.
Data from 7,637 patients with pT1-2N0M0 TSCC who underwent surgery between 2000 and 2021 were extracted from the SEER database. Patients were randomly divided into a training cohort and a validation cohort in a 2:1 ratio. Prognostic factors were identified via Kaplan-Meier analysis and Cox regression, and a nomogram was constructed. To minimize confounding, propensity score matching (PSM) was used to compare outcomes between patients who received PORT and those who did not. Subgroup and interaction analyses were performed to assess potential effect modifiers.
Of the 7,637 patients included, 1,336 (17.5%) received PORT. Multivariate Cox analysis identified age, race, marital status, grade, tumor size, lymph node (LN) removed status, and PORT as independent prognostic factors for OS and CSS. The nomogram demonstrated strong predictive performance based on time-dependent ROC curves, concordance indices, calibration plots, and decision curve analyses in both training and validation cohorts. After PSM, PORT remained associated with worse OS and CSS. Subgroup analyses revealed that the association between PORT and poorer OS was most evident in younger patients, married individuals, T1 stage patients, those with smaller tumors, and those without LN removal, with racial disparities also observed. For CSS, this association was more pronounced in married individuals, well-differentiated patients, T1 stage patients, those with smaller tumors, and those without LN removal.
The SEER-based nomogram provides survival predictions for postoperative pT1-2N0M0 TSCC patients. Although PORT was associated with worse survival in several subgroups, findings should be cautiously interpreted given the observational design and absence of key clinical variables (PNI, LVI, surgical margins). Prospective studies incorporating comprehensive clinicopathological data are warranted to confirm associations and guide individualized PORT decisions in early-stage TSCC patients.
建立一种列线图，用于预测术后早期（pT1-2N0M0）舌鳞状细胞癌（TSCC）患者的总生存期（OS）和癌症特异性生存期（CSS），并探讨术后放疗（PORT）与患者生存之间的关联。
从监测、流行病学和最终结果（SEER）数据库中提取2000年至2021年间接受手术的7637例pT1-2N0M0 TSCC患者的数据。患者按2:1的比例随机分为训练队列和验证队列。通过Kaplan-Meier分析和Cox回归确定预后因素，并构建列线图。为了尽量减少混杂因素，采用倾向评分匹配（PSM）来比较接受PORT的患者和未接受PORT的患者的结局。进行亚组分析和交互分析以评估潜在的效应修饰因素。
在纳入的7637例患者中，1336例（17.5%）接受了PORT。多因素Cox分析确定年龄、种族、婚姻状况、分级、肿瘤大小、淋巴结（LN）切除状态和PORT是OS和CSS的独立预后因素。列线图在训练队列和验证队列中基于时间依赖性ROC曲线、一致性指数、校准图和决策曲线分析显示出强大的预测性能。PSM后，PORT仍然与较差的OS和CSS相关。亚组分析显示，PORT与较差OS之间的关联在年轻患者、已婚个体、T1期患者、肿瘤较小的患者以及未切除LN的患者中最为明显，也观察到种族差异。对于CSS，这种关联在已婚个体、高分化患者、T1期患者中更为明显。肿瘤较小的患者以及未切除LN的患者。
基于SEER的列线图为术后pT1-2N0M0 TSCC患者提供生存预测。尽管PORT在几个亚组中与较差的生存相关，但鉴于观察性设计和关键临床变量（PNI、LVI、手术切缘）的缺乏，研究结果应谨慎解释。有必要进行纳入全面临床病理数据的前瞻性研究，以证实关联并指导早期TSCC患者的个体化PORT决策。
