Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer

Carole Fakhry, Qiang Zhang, Phuc Felix Nguyen-Tân, David I. Rosenthal, Randal S. Weber, Louise Lambert, Andy M. Trotti, William L. Barrett, Wade L. Thorstad, Christopher U. Jones, Sue S. Yom, Stuart J. Wong, John A. Ridge, Shyam Rao, James A. Bonner, Eric Vigneault, David Raben, Mahesh R. Kudrimoti, Jonathan Harris, Quynh Thu Le & 1 others Maura L. Gillison

Research output: Contribution to journalArticle

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Abstract

Purpose: Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods: To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and crossvalidation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results: Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P =.003;<.001). Conclusion: The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.

Original languageEnglish (US)
Pages (from-to)4057-4065
Number of pages9
JournalJournal of Clinical Oncology
Volume35
Issue number36
DOIs
StatePublished - Dec 20 2017

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Oropharyngeal Neoplasms
Nomograms
Disease-Free Survival
Survival
Squamous Cell Carcinoma
Radiation Oncology
Radiotherapy
Marital Status
Chemoradiotherapy
Platinum
Proportional Hazards Models
Calibration
Anemia
Weight Loss
Smoking
History
Clinical Trials
Education
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Fakhry, C., Zhang, Q., Nguyen-Tân, P. F., Rosenthal, D. I., Weber, R. S., Lambert, L., ... Gillison, M. L. (2017). Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. Journal of Clinical Oncology, 35(36), 4057-4065. https://doi.org/10.1200/JCO.2016.72.0748

Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. / Fakhry, Carole; Zhang, Qiang; Nguyen-Tân, Phuc Felix; Rosenthal, David I.; Weber, Randal S.; Lambert, Louise; Trotti, Andy M.; Barrett, William L.; Thorstad, Wade L.; Jones, Christopher U.; Yom, Sue S.; Wong, Stuart J.; Ridge, John A.; Rao, Shyam; Bonner, James A.; Vigneault, Eric; Raben, David; Kudrimoti, Mahesh R.; Harris, Jonathan; Le, Quynh Thu; Gillison, Maura L.

In: Journal of Clinical Oncology, Vol. 35, No. 36, 20.12.2017, p. 4057-4065.

Research output: Contribution to journalArticle

Fakhry, C, Zhang, Q, Nguyen-Tân, PF, Rosenthal, DI, Weber, RS, Lambert, L, Trotti, AM, Barrett, WL, Thorstad, WL, Jones, CU, Yom, SS, Wong, SJ, Ridge, JA, Rao, S, Bonner, JA, Vigneault, E, Raben, D, Kudrimoti, MR, Harris, J, Le, QT & Gillison, ML 2017, 'Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer', Journal of Clinical Oncology, vol. 35, no. 36, pp. 4057-4065. https://doi.org/10.1200/JCO.2016.72.0748
Fakhry, Carole ; Zhang, Qiang ; Nguyen-Tân, Phuc Felix ; Rosenthal, David I. ; Weber, Randal S. ; Lambert, Louise ; Trotti, Andy M. ; Barrett, William L. ; Thorstad, Wade L. ; Jones, Christopher U. ; Yom, Sue S. ; Wong, Stuart J. ; Ridge, John A. ; Rao, Shyam ; Bonner, James A. ; Vigneault, Eric ; Raben, David ; Kudrimoti, Mahesh R. ; Harris, Jonathan ; Le, Quynh Thu ; Gillison, Maura L. / Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer. In: Journal of Clinical Oncology. 2017 ; Vol. 35, No. 36. pp. 4057-4065.
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abstract = "Purpose: Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods: To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and crossvalidation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results: Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95{\%} CI, 0.72 to 0.80) for OS and 0.70 (95{\%} CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P =.003;<.001). Conclusion: The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.",
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T1 - Development and validation of nomograms predictive of overall and progression-free survival in patients with oropharyngeal cancer

AU - Fakhry, Carole

AU - Zhang, Qiang

AU - Nguyen-Tân, Phuc Felix

AU - Rosenthal, David I.

AU - Weber, Randal S.

AU - Lambert, Louise

AU - Trotti, Andy M.

AU - Barrett, William L.

AU - Thorstad, Wade L.

AU - Jones, Christopher U.

AU - Yom, Sue S.

AU - Wong, Stuart J.

AU - Ridge, John A.

AU - Rao, Shyam

AU - Bonner, James A.

AU - Vigneault, Eric

AU - Raben, David

AU - Kudrimoti, Mahesh R.

AU - Harris, Jonathan

AU - Le, Quynh Thu

AU - Gillison, Maura L.

PY - 2017/12/20

Y1 - 2017/12/20

N2 - Purpose: Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods: To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and crossvalidation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results: Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P =.003;<.001). Conclusion: The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.

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