Abstract
BackgroundInduction chemotherapy (IC) significantly improves the rate of larynx preservation; however, some patients could not benefit from it. Hence, it is of clinical importance to predict the response to IC to determine the necessity of IC. We aimed to develop a clinical nomogram for predicting the treatment response to IC in locally advanced hypopharyngeal carcinoma.MethodsWe retrospectively include a total of 127 patients with locally advanced hypopharyngeal carcinoma who underwent MRI scans prior to IC between January 2014 and December 2017. The clinical characteristics were collected, which included age, sex, tumor location, invading sites, histological grades, T-stage, N-stage, overall stage, size of the largest lymph node, neutrophil-to-lymphocyte ratio, hemoglobin concentration, and platelet count. Univariate and multivariate logistic regression was used to select the significant predictors of IC response. A nomogram was built based on the results of stepwise logistic regression analysis. The predictive performance and clinical usefulness of the nomogram were determined based on the area under the curve (AUC), calibration curve, and decision curve.ResultsAge, T-stage, hemoglobin, and platelet were four independent predictors of IC treatment response, which were incorporated into the nomogram. The AUC of the nomogram was 0.860 (95% confidence interval [CI]: 0.780-0.940), which was validated using 3-fold cross-validation (AUC, 0.864; 95% CI: 0.755-0.973). The calibration curve demonstrated good consistency between the prediction by the nomogram and actual observation. Decision curve analysis shows that the nomogram was clinically useful.ConclusionThe proposed nomogram resulted in an accurate prediction of the efficacy of IC for patients with locally advanced hypopharyngeal carcinoma.
Highlights
Hypopharyngeal carcinoma is an uncommon tumor, which accounts for approximately 3%–5% of mucosal head and neck subsites [1]
We aimed to develop a clinical nomogram for predicting the treatment response to induction chemotherapy (IC) in locally advanced hypopharyngeal carcinoma
Age, T-stage, hemoglobin, and platelet were four independent predictors of IC treatment response, which were incorporated into the nomogram
Summary
Hypopharyngeal carcinoma is an uncommon tumor, which accounts for approximately 3%–5% of mucosal head and neck subsites [1]. Over 2/3 of patients present with locally advanced stages of the disease [3]. Some progress has been achieved in treatment management, patients with advanced hypopharyngeal carcinoma still have a poor prognosis with a 5-year overall survival rate of only 25%–40% [4]. Induction chemotherapy (IC) with docetaxel, cisplatin, 5-fluorouracil (TPF) is regarded as a strong predictor of radiosensitivity and the landmark treatment of nonsurgical larynx-preservation approaches [6]. TPF-based IC has been proved to significantly improve the rate of larynx preservation. Induction chemotherapy (IC) significantly improves the rate of larynx preservation; some patients could not benefit from it. We aimed to develop a clinical nomogram for predicting the treatment response to IC in locally advanced hypopharyngeal carcinoma
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