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Original Article
ONLINE FIRST
June 2013

An Oral Cavity Carcinoma Nomogram to Predict Benefit of Adjuvant Radiotherapy

Author Affiliations

Author Affiliations: Departments of Radiation Medicine (Drs Wang and Holland and Ms Lockhart), Medical Informatics and Clinical Epidemiology (Dr Wang), and Otolaryngology–Head and Neck Surgery (Dr Gross), Oregon Health & Science University, Portland; Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Patel and Shah); Departments of Otolaryngology–Head and Neck Surgery and Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada (Drs Goldstein and Irish); Barretos Cancer Hospital, Barretos, Brazil (Dr Carvalho); and Head and Neck Surgery and Otorhinolaryngology Department, Hospital AC Camargo, São Paulo, Brazil (Dr Kowalski).

JAMA Otolaryngol Head Neck Surg. 2013;139(6):554-559. doi:10.1001/jamaoto.2013.3001
Abstract

Importance After surgical resection for oral cavity squamous cell carcinoma, adjuvant radiotherapy may be recommended for patients at higher risk for locoregional recurrence, but it can be difficult to predict whether a particular patient will benefit.

Objective To construct a model to predict which patients with oral cavity squamous cell carcinoma would benefit from adjuvant radiotherapy.

Design and Setting We constructed several types of survival models using a set of 979 patients with oral cavity squamous cell carcinoma. Covariates were age, sex, tobacco use, stage, grade, margins, and subsite. The best performing model was externally validated on a set of 431 patients.

Participants The model was based on a set of 979 patients with oral cavity squamous cell carcinoma, including 563 from Memorial Sloan Kettering Cancer Center, New York, New York, and 416 from the Hospital AC Camargo, São Paulo, Brazil. The validation set consisted of 431 patients from Princess Margaret Hospital, Toronto, Ontario, Canada.

Main Outcome and Measure The primary outcome measure of interest was locoregional recurrence-free survival.

Results The lognormal model showed the best performance per the Akaike information criterion. An online nomogram was built from this model that estimates locoregional failure-free survival with and without postoperative radiotherapy.

Conclusions and Relevance A web-based nomogram can be used as a decision aid for adjuvant treatment decisions for patients with oral cavity squamous cell carcinoma.

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