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Description

Raab et al reported a nomogram for predicting early mortality for a patient being treated for head and neck cancer using radiation and chemotherapy. One group was treated with definitive therapy while a second received adjuvant therapy. The authors are from Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, and UC San Diego.


Patient selection: nonmetastatic (M0) head and neck cancer, following adjuvant therapy (surgery for primary tumor within 90 days prior to chemoradiation)

 

Outcome: death within 90 days after starting radiati0n therapy (had surgery for primary tumor before starting chemoradiation)

 

Parameters:

(1) cancer site

(2) comorbidities (Charlson-Deyo comorbidity score)

(3) age at diagnosis, from 10 to 100 years

(4) T category

(5) N category

 

points for age =

= (1.25 * (age)) - 12.5

 

Parameter

Finding

Points

cancer site

oropharynx

0

 

larynx

20.3

 

hypopharynx

4.8

 

oral cavity

31.2

number of comorbidities

0

0

 

1

2.3

 

2

5.7

 

>= 3

25.4

T category

T0, T1, T2

0

 

T3 or T4

25.8

N category

N0, N1

0

 

N2, N3

21.6

 

total score =

= SUM(points for all of the parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 203.9.

 

value of X =

= (0.02795 * (score)) - 6.987

 

risk of 90-day mortality after adjuvant therapy =

= 1 / (1 + EXP((-10 * X))

 

Performance:

• The area under the ROC curve is 0.70 in the training and 0.61 in the validation cohorts.


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