Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging

Emmanuel Rios Velazquez, Frank Hoebers, Hugo J W L Aerts, Michelle M Rietbergen, Ruud H Brakenhoff, René C Leemans, Ernst-Jan Speel, Jos Straetmans, Bernd Kremer, Philippe Lambin

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)

Abstract

PURPOSE: Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualized predictions of treatment outcome in oropharyngeal carcinoma patients.

METHODS: We analyzed the association between clinico-pathological factors and overall and progression-free survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemo-radiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org.

RESULTS: Predictors of unfavorable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower hemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95% CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95% CI, 0.66-0.79. For progression-free survival, the model's C-index was 0.80 (95% CI, 0.76-0.88), with a validation C-index of 0.67, (95% CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001).

CONCLUSION: This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualized predictions could be used to stratify patients for treatment de-escalation trials.

Original languageEnglish
Pages (from-to)324-30
Number of pages7
JournalRadiotherapy and Oncology
Volume113
Issue number3
DOIs
Publication statusPublished - Dec 2014

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell
  • Chemoradiotherapy
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Nomograms
  • Oropharyngeal Neoplasms
  • Papillomaviridae
  • Polymerase Chain Reaction
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Severity of Illness Index
  • Sex Factors
  • Treatment Outcome

Cite this

Rios Velazquez, Emmanuel ; Hoebers, Frank ; Aerts, Hugo J W L ; Rietbergen, Michelle M ; Brakenhoff, Ruud H ; Leemans, René C ; Speel, Ernst-Jan ; Straetmans, Jos ; Kremer, Bernd ; Lambin, Philippe. / Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging. In: Radiotherapy and Oncology. 2014 ; Vol. 113, No. 3. pp. 324-30.
@article{95a8c44b39984a3ba0a9bba9dadff3d4,
title = "Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging",
abstract = "PURPOSE: Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualized predictions of treatment outcome in oropharyngeal carcinoma patients.METHODS: We analyzed the association between clinico-pathological factors and overall and progression-free survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemo-radiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org.RESULTS: Predictors of unfavorable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower hemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95{\%} CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95{\%} CI, 0.66-0.79. For progression-free survival, the model's C-index was 0.80 (95{\%} CI, 0.76-0.88), with a validation C-index of 0.67, (95{\%} CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001).CONCLUSION: This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualized predictions could be used to stratify patients for treatment de-escalation trials.",
keywords = "Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell, Chemoradiotherapy, Disease-Free Survival, Female, Head and Neck Neoplasms, Humans, Male, Middle Aged, Neoplasm Staging, Nomograms, Oropharyngeal Neoplasms, Papillomaviridae, Polymerase Chain Reaction, Predictive Value of Tests, Prognosis, Reproducibility of Results, Severity of Illness Index, Sex Factors, Treatment Outcome",
author = "{Rios Velazquez}, Emmanuel and Frank Hoebers and Aerts, {Hugo J W L} and Rietbergen, {Michelle M} and Brakenhoff, {Ruud H} and Leemans, {Ren{\'e} C} and Ernst-Jan Speel and Jos Straetmans and Bernd Kremer and Philippe Lambin",
note = "Copyright {\circledC} 2014 Elsevier Ireland Ltd. All rights reserved.",
year = "2014",
month = "12",
doi = "10.1016/j.radonc.2014.09.005",
language = "English",
volume = "113",
pages = "324--30",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging. / Rios Velazquez, Emmanuel; Hoebers, Frank; Aerts, Hugo J W L; Rietbergen, Michelle M; Brakenhoff, Ruud H; Leemans, René C; Speel, Ernst-Jan; Straetmans, Jos; Kremer, Bernd; Lambin, Philippe.

In: Radiotherapy and Oncology, Vol. 113, No. 3, 12.2014, p. 324-30.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Externally validated HPV-based prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging

AU - Rios Velazquez, Emmanuel

AU - Hoebers, Frank

AU - Aerts, Hugo J W L

AU - Rietbergen, Michelle M

AU - Brakenhoff, Ruud H

AU - Leemans, René C

AU - Speel, Ernst-Jan

AU - Straetmans, Jos

AU - Kremer, Bernd

AU - Lambin, Philippe

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/12

Y1 - 2014/12

N2 - PURPOSE: Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualized predictions of treatment outcome in oropharyngeal carcinoma patients.METHODS: We analyzed the association between clinico-pathological factors and overall and progression-free survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemo-radiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org.RESULTS: Predictors of unfavorable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower hemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95% CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95% CI, 0.66-0.79. For progression-free survival, the model's C-index was 0.80 (95% CI, 0.76-0.88), with a validation C-index of 0.67, (95% CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001).CONCLUSION: This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualized predictions could be used to stratify patients for treatment de-escalation trials.

AB - PURPOSE: Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualized predictions of treatment outcome in oropharyngeal carcinoma patients.METHODS: We analyzed the association between clinico-pathological factors and overall and progression-free survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemo-radiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org.RESULTS: Predictors of unfavorable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower hemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95% CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95% CI, 0.66-0.79. For progression-free survival, the model's C-index was 0.80 (95% CI, 0.76-0.88), with a validation C-index of 0.67, (95% CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001).CONCLUSION: This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualized predictions could be used to stratify patients for treatment de-escalation trials.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Squamous Cell

KW - Chemoradiotherapy

KW - Disease-Free Survival

KW - Female

KW - Head and Neck Neoplasms

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Nomograms

KW - Oropharyngeal Neoplasms

KW - Papillomaviridae

KW - Polymerase Chain Reaction

KW - Predictive Value of Tests

KW - Prognosis

KW - Reproducibility of Results

KW - Severity of Illness Index

KW - Sex Factors

KW - Treatment Outcome

U2 - 10.1016/j.radonc.2014.09.005

DO - 10.1016/j.radonc.2014.09.005

M3 - Article

C2 - 25443497

VL - 113

SP - 324

EP - 330

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

IS - 3

ER -