Nomogram to Predict Risk of Early Mortality Following Definitive or Adjuvant Radiation and Systemic Therapy for Head and Neck Cancer

Abstract

Tools to predict individual patient risk for early mortality in head and neck cancer patients receiving chemoradiation are lacking. We sought to create a nomogram to predict individual risk of early mortality, which may help identify patients who require interventions to prevent early death. We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in either the definitive or adjuvant setting. Covariates analyzed in the cohort include race, gender, income, age, T and N category, tumor site, insurance type, facility type, urban or rural environment, radiation modality, and comorbidity. Early mortality was defined as any death less than 90 days after the beginning of radiation. Chi-squared analysis was used for all categorical covariates and t-tests were used for continuous variables to test for associations with early mortality. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. The final cohorts included 84,563 patients in the definitive group and 18,514 patients in the adjuvant group. Rates of early mortality were 3.5% (95% CI 3.4-3.7%) and 2.2% (95% CI 1.9-2.4%) in the definitive and adjuvant cohorts, respectively. Patients above the age of 70 had an early mortality rate of 7.8% (95% CI 7.3-8.2%) in the definitive group and 4.4% (95% CI 3.6-5.4%) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p<0.05 for all); while in the definitive group, radiation type, year of diagnosis, and insurance status were also statistically significant (p<0.05). In both cohorts, nomograms were created to predict the risk of early mortality that included age, comorbidity, T and N category and tumor site. The nomogram including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.