A prognostic nomogram for predicting the long-term survival outcome of hypopharyngeal squamous cell carcinoma patients after tumour resection to assist the decision-making of postoperative adjuvant treatment

Abstract

BackgroundSurgery remains the most common therapeutic strategy for Chinese patients with hypopharyngeal squamous cell carcinoma (HSCC), yet the indications for postoperative adjuvant treatment (POAT) remain unclear. MethodsWe retrospectively analysed 385 patients with primary HSCC in our hospital between 2003 and 2014. Patients that received pharyngectomy without POAT were enrolled in this study for developing a nomogram that predicts their survival outcome. ResultsMultivariate analyses showed that the tumour size, oesophagal invasion, extracapsular spread or internal jugular vein adhesion, thyroid gland invasion, and the number of lymph node metastases (≤3 or >3) were significantly correlated to the overall survival (OS) of the patient and were included as risk factors in the nomogram. The C-index was 0.768 (95% CI, 0.719–0.817) in development cohort and 0.767 (95% CI, 0.753–0.781) in validation cohort. A calibration curve was also conducted and was found favourable. The patients were stratified into three groups based on their nomogram scores. In the high-risk group, patients that received POAT had a better OS than those that received only surgery. In the moderate-risk group, POAT did not show any significant association with the OS. However, patients in the low-risk group that received POAT showed a worse OS than those without. ConclusionThe newly-developed nomogram can effectively predict the survival outcome of patients with HSCC. According to the novel stratification criteria created, patients stratified as high-risk could benefit from POAT, while those in the low-risk group are advised not to receive POAT as this correlates with a worse OS.