Skip to main content
SpringerLink
Log in

A predictive survival model for patients with stage IV oropharyngeal squamous cell carcinoma treated with chemoradiation

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the pre-treatment and post-treatment clinical factors associated with rate of survival at 1, 3, and 5 years in stage IV oropharyngeal cancer patients treated with concurrent chemoradiation with/without neoadjuvant chemotherapy.

Methods

This retrospective cohort study involved 128 Stage IV oropharyngeal cancer patients that were treated at our tertiary referral center between 2008 and 2020. The pre-treatment and post-treatment clinical parameters including nutritional status and inflammatory markers were retrospectively reviewed.

Results

The 5-year overall survival rate for all patients was 36.72%. The disease-specific survival (DSS) at 1-year and 3-year were 80% and 63%, whereas the disease-free survival (DFS) at 1-year and 3-year were 49% and 40%, respectively. In multivariate analyses, pretreatment hemoglobin (Hb) < 12 g/dL (hazard ratio [HR] 2.551, 95% confidence interval [CI] 1.366–4.762, p = 0.003), pretreatment systemic immune inflammation (SII) ≥ 1751 (HR 2.173, 95% CI 1.015–4.652, p = 0.046), and posttreatment systemic inflammation response index (SIRI) ≥ 261 (HR 2.074, 95% CI 1.045–4.115, p = 0.037) were independent indicators for worsened DSS. Pretreatment Hb < 12 g/dl (HR 1.692, 95% CI 1.019–2.809, p = 0.032), pretreatment SII ≥ 1751 (HR 1.968, 95% CI 1.061–3.650, p = 0.032), and posttreatment SII ≥ 1690 (HR 1.922, 95% CI 1.105–3.345, p = 0.021) were independent indicators for worsened DFS. A nomogram was developed using pretreatment Hb, pretreatment SII, and posttreatment SIRI to forecast DSS.

Conclusions

The pretreatment Hb, pretreatment SII, posttreatment SII, and posttreatment SIRI are associated with survival in patients with stage IV oropharyngeal cancers. The developed nomogram aids in survival prediction and treatment adjustment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data produced and analyzed throughout the study can be obtained from the corresponding author of the study upon a reasonable request.

References

  1. Ferlay J, Colombet M, Soerjomataram I et al (2019) Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 144:1941–1953

    Article  PubMed  CAS  Google Scholar 

  2. Dahlstrom KR, Calzada G, Hanby JD et al (2013) An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center: a staging system in need of repair. Cancer 119:81–89

    Article  PubMed  Google Scholar 

  3. Wang C-P, Chen T-C, Hsu W-L et al (2022) Rising incidence of HPV positive oropharyngeal cancer in Taiwan between 1999 and 2014 where betel nut chewing is common. BMC Cancer 22:296

    Article  PubMed  PubMed Central  Google Scholar 

  4. Damgacioglu H, Sonawane K, Chhatwal J et al (2022) Long-term impact of HPV vaccination and COVID-19 pandemic on oropharyngeal cancer incidence and burden among men in the USA: A modeling study. Lancet Reg Health Am 8:100143

    PubMed  Google Scholar 

  5. Chaturvedi AK, Engels EA, Pfeiffer RM et al (2011) Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29:4294–4301

    Article  PubMed  Google Scholar 

  6. Kang JJ, Yu Y, Chen L et al. (2023) Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer. CA: A Cancer Journal for Clinicians. 73:164–197.

  7. Lo W-C, Chang C-M, Wu C-Y et al (2022) A predictive model for advanced oropharyngeal cancer patients treated with chemoradiation. BMC Cancer 22:615

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rockwell S, Dobrucki IT, Kim EY, Marrison ST, Vu VT (2009) Hypoxia and radiation therapy: past history, ongoing research, and future promise. Curr Mol Med 9:442–458

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Stadler P, Becker A, Jürgen Feldmann H et al (1999) Influence of the hypoxic subvolume on the survival of patients with head and neck cancer. Int J Radiat Oncol Biol Phys 44:749–754

    Article  PubMed  CAS  Google Scholar 

  10. Hughes VS, Wiggins JM, Siemann DW (2019) Tumor oxygenation and cancer therapy—then and now. Br J Radiol 92:20170955

    PubMed  Google Scholar 

  11. Pai P-C, Chuang C-C, Tseng C-K et al. (2012) Impact of Pretreatment Body Mass Index on Patients With Head-and-Neck Cancer Treated With Radiation. International Journal of Radiation Oncology*Biology*Physics. 83:e93-e100.

  12. Tazzyman S, Lewis CE, Murdoch C (2009) Neutrophils: key mediators of tumour angiogenesis. Int J Exp Pathol 90:222–231

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Shen M, Hu P, Donskov F, Wang G, Liu Q, Du J (2014) Tumor-associated neutrophils as a new prognostic factor in cancer: a systematic review and meta-analysis. PLoS ONE 9:e98259

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wallis SP, Stafford ND, Greenman J (2015) Clinical relevance of immune parameters in the tumor microenvironment of head and neck cancers. Head Neck 37:449–459

    Article  PubMed  Google Scholar 

  15. Palacios-Acedo AL, Mège D, Crescence L, Dignat-George F, Dubois C, Panicot-Dubois L (2019) Platelets, Thrombo-Inflammation, and Cancer: Collaborating With the Enemy. Front Immunol 10:1805

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Mascarella MA, Mannard E, Silva SD, Zeitouni A (2018) Neutrophil-to-lymphocyte ratio in head and neck cancer prognosis: A systematic review and meta-analysis. Head Neck 40:1091–1100

    Article  PubMed  Google Scholar 

  17. Howard R, Kanetsky PA, Egan KM (2019) Exploring the prognostic value of the neutrophil-to-lymphocyte ratio in cancer. Sci Rep 9:19673

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Takenaka Y, Oya R, Kitamiura T et al (2018) Prognostic role of neutrophil-to-lymphocyte ratio in head and neck cancer: A meta-analysis. Head Neck 40:647–655

    Article  PubMed  Google Scholar 

  19. Valero C, Pardo L, Sansa A et al (2020) Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma. Head Neck 42:336–343

    Article  PubMed  Google Scholar 

  20. Brewczyński A, Jabłońska B, Mazurek AM et al (2021) Comparison of Selected Immune and Hematological Parameters and Their Impact on Survival in Patients with HPV-Related and HPV-Unrelated Oropharyngeal Cancer. Cancers (Basel) 13:3256

    Article  PubMed  Google Scholar 

  21. Boscolo-Rizzo P, D’Alessandro A, Polesel J et al (2022) Different inflammatory blood markers correlate with specific outcomes in incident HPV-negative head and neck squamous cell carcinoma: a retrospective cohort study. BMC Cancer 22:243

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Edge SB, Compton CC. (2010) The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Annals of Surgical Oncology. 17:1471–1474.

  23. National Comprehensive Cancer Network I. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers (Version 1.2023) 2023. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437.

  24. Melo-Alvim C, Miguel-Semedo P, Paiva RS et al (2020) Pretreatment hemoglobin level as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma. Rep Pract Oncol Radiother 25:768–774

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gorphe P, Chekkoury Idrissi Y, Tao Y et al (2018) Anemia and neutrophil-to-lymphocyte ratio are prognostic in p16-positive oropharyngeal carcinoma treated with concurrent chemoradiation. Papillomavirus Res 5:32–37

    Article  PubMed  Google Scholar 

  26. Siemann DW, Horsman MR (2015) Modulation of the tumor vasculature and oxygenation to improve therapy. Pharmacol Ther 153:107–124

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Semenza GL (2003) Targeting HIF-1 for cancer therapy. Nat Rev Cancer 3:721–732

    Article  PubMed  CAS  Google Scholar 

  28. Bristow RG, Hill RP (2008) Hypoxia, DNA repair and genetic instability. Nat Rev Cancer 8:180–192

    Article  PubMed  CAS  Google Scholar 

  29. Shenouda G, Zhang Q, Ang KK et al (2015) Long-term results of radiation therapy oncology group 9903: a randomized phase 3 trial to assess the effect of erythropoietin on local-regional control in anemic patients treated with radiation therapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 91:907–915

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Overgaard J, Hoff CM, Hansen HS et al (2018) DAHANCA 10 - Effect of darbepoetin alfa and radiotherapy in the treatment of squamous cell carcinoma of the head and neck. A multicenter, open-label, randomized, phase 3 trial by the Danish head and neck cancer group. Radiother Oncol 127:12–19

    Article  PubMed  CAS  Google Scholar 

  31. Welsh L, Panek R, Riddell A et al (2017) Blood transfusion during radical chemo-radiotherapy does not reduce tumour hypoxia in squamous cell cancer of the head and neck. Br J Cancer 116:28–35

    Article  PubMed  CAS  Google Scholar 

  32. Janowska-Wieczorek A, Wysoczynski M, Kijowski J et al (2005) Microvesicles derived from activated platelets induce metastasis and angiogenesis in lung cancer. Int J Cancer 113:752–760

    Article  PubMed  CAS  Google Scholar 

  33. Wang YT, Kuo LT, Weng HH et al (2022) Systemic Immun e-Inflammation Index as a Predictor for Head and Neck Cancer Prognosis: A Meta-Analysis. Front Oncol 12:899518

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Chen Y, Jiang W, Xi D et al (2019) Development and validation of nomogram based on SIRI for predicting the clinical outcome in patients with nasopharyngeal carcinomas. J Investig Med 67:691–698

    Article  PubMed  Google Scholar 

  35. Atasever Akkas E, Erdis E, Yucel B (2023) Prognostic value of the systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index in head and neck cancer. Eur Arch Otorhinolaryngol 280:3821–3830

    Article  PubMed  Google Scholar 

  36. Amin MB, Greene FL, Edge SB et al. (2017) The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 67:93–99.

Download references

Acknowledgements

The authors thank the patients for their participation in the study.

Funding

This study was supported by grants of Far Eastern Memorial Hospital (FEMH-2023-C-030), Taiwan.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Pan Chiao District, 220, New Taipei City, Taiwan

    Peng Yeh, Chih-Ming Chang, Li-Jen Liao, Po-Wen Cheng & Wu-Chia Lo

  2. Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chih-Ming Chang

  3. Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Li-Jen Liao, Chia-Yun Wu, Chen-Hsi Hsieh & Wu-Chia Lo

  4. Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan

    Li-Jen Liao

  5. Department of Oncology and Hematology, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Chia-Yun Wu

  6. Department of Radiology, Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Chen-Hsi Hsieh & Pei-Wei Shueng

  7. Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chen-Hsi Hsieh & Pei-Wei Shueng

  8. Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan

    Wu-Chia Lo

Authors
  1. Peng Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chih-Ming Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-Jen Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chia-Yun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chen-Hsi Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pei-Wei Shueng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Po-Wen Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wu-Chia Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PY: study concept and design, analysis and interpretation of data, and drafting of the manuscript. C-MC: data collection, analysis and interpretation of data. L-JL: data collection, study concept and design. C-YW: data collection, analysis and interpretation of data. C-HH: data collection, analysis and interpretation of data. P-WS: analysis and interpretation of data. P-WC: data collection, administrative, technical, and material support. W-CL: study concept and design, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript.

Corresponding author

Correspondence to Wu-Chia Lo.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethics approval

The study was approved by the Institutional Review Board (Far Eastern Memorial Hospital 111223-E) in a tertiary hospital. Waiver of informed consent was approved by the Research Ethics Review Committee of Far Eastern Memorial Hospital (No. 111223-E) as this is a retrospective anonymous study. This study complies fully with the Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 KB)

Supplementary file2 (DOCX 18 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yeh, P., Chang, CM., Liao, LJ. et al. A predictive survival model for patients with stage IV oropharyngeal squamous cell carcinoma treated with chemoradiation. Eur Arch Otorhinolaryngol 281, 369–377 (2024). https://doi.org/10.1007/s00405-023-08187-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-023-08187-3

Keywords

Search

Navigation