Individualized survival prediction for patients with oropharyngeal cancer in the human papillomavirus era.

Autor: Beesley LJ; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan., Hawkins PG; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan., Amlani LM; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Bellile EL; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan., Casper KA; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Chinn SB; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Eisbruch A; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan., Mierzwa ML; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan., Spector ME; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Wolf GT; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Shuman AG; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan., Taylor JMG; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2019 Jan 01; Vol. 125 (1), pp. 68-78. Date of Electronic Publication: 2018 Oct 06.
DOI: 10.1002/cncr.31739
Abstrakt: Background: Accurate, individualized prognostication in patients with oropharyngeal squamous cell carcinoma (OPSCC) is vital for patient counseling and treatment decision making. With the emergence of human papillomavirus (HPV) as an important biomarker in OPSCC, calculators incorporating this variable have been developed. However, it is critical to characterize their accuracy prior to implementation.
Methods: Four OPSCC calculators were identified that integrate HPV into their estimation of 5-year overall survival. Treatment outcomes for 856 patients with OPSCC who were evaluated at a single institution from 2003 through 2016 were analyzed. Predicted survival probabilities were generated for each patient using each calculator. Calculator performance was assessed and compared using Kaplan-Meier plots, receiver operating characteristic curves, concordance statistics, and calibration plots.
Results: Correlation between pairs of calculators varied, with coefficients ranging from 0.63 to 0.90. Only 3 of 6 pairs of calculators yielded predictions within 10% of each other for at least 50% of patients. Kaplan-Meier curves of calculator-defined risk groups demonstrated reasonable stratification. Areas under the receiver operating characteristic curve ranged from 0.74 to 0.80, and concordance statistics ranged from 0.71 to 0.78. Each calculator demonstrated superior discriminatory ability compared with clinical staging according to the seventh and eighth editions of the American Joint Committee on Cancer staging manual. Among models, the Denmark calculator was found to be best calibrated to observed outcomes.
Conclusions: Existing calculators exhibited reasonable estimation of survival in patients with OPSCC, but there was considerable variability in predictions for individual patients, which limits the clinical usefulness of these calculators. Given the increasing role of personalized treatment in patients with OPSCC, further work is needed to improve accuracy and precision, possibly through the identification and incorporation of additional biomarkers.
(© 2018 American Cancer Society.)
Databáze: MEDLINE
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