Development and validation of a novel prognostic score for elderly head-and-neck cancer patients undergoing radiotherapy or chemoradiation. (January 2021)

• Record Type: Journal Article
• Authors: Rühle, Alexander; Stromberger, Carmen; Haehl, Erik; Senger, Carolin; David, Hélène; Stoian, Raluca; Zamboglou, Constantinos; Knopf, Andreas; Budach, Volker; Grosu, Anca-Ligia; Nicolay, Nils H.
• Is Part Of: Radiotherapy and oncology. Volume 154(2021)
• Page Start: 276
• Page End: 282
• Publication Date: 2021-01
• Subjects: Head-and-neck cancer -- Radiotherapy -- Elderly patients -- Geriatric patients -- Prognostic score; -- Nomogram; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2020.11.023
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: The survival score stratifies elderly HNSCC patients in 3 prognostic groups. The score is based on performance status, comorbidity burden and baseline CRP level. The score for elderly HNSCC patients having radiotherapy was externally validated. The developed nomogram predicts 2- and 4-year overall survival of this cohort. Abstract: Background and purpose: To establish a clinically feasible prognostic score and nomogram based on easily accessible clinical data that will aid decision-making in elderly head-and-neck squamous cell carcinoma (HNSCC) patients undergoing (chemo)radiotherapy. Material and methods: 284 elderly HNSCC patients (≥65 years) undergoing curative (chemo)radiotherapy were included for the development of a score predicting overall survival (OS) based on the beta regression coefficients from significant parameters in a multivariate Cox regression analysis with p < 0.1 as inclusion criterion. A second, external cohort of 217 elderly HNSCC patients receiving (chemo)radiotherapy was used for validation. Using the aggregated data ( n = 501), a nomogram was developed to predict 2- and 4-year OS. Results: Karnofsky Performance Status (HR = 2.654; p < 0.001), Charlson Comorbidity Index (HR = 2.598; p < 0.001) and baseline C-reactive protein (CRP) level (HR = 1.634; p = 0.068) were prognostic for OS in the multivariate analysis. An OS score based on beta regression coefficients was created, in which reduced performance status, increased comorbidity burden and increased CRP levels were included, leading to 3 distinct survival groups. The median OS for the 3 groups amounted to 107, 28 and 6 months, respectively ( p < 0.001). The developed score was able to significantly differentiate between a favorable (median OS = 130 months), intermediate (29 months) and unfavorable prognosis (9 months) also in the external validation cohort ( p = 0.005). Conclusion: We propose a novel, validated prognostic score based on easily accessible clinical data allowing stratification between prognostic groups of elderly HNSCC patients receiving (chemo)radiotherapy. The derived nomogram for the prediction of 2-year and 4-year OS may aid decision-making for this vulnerable population.