Original Article | ONLINE FIRST

An Oral Cavity Carcinoma Nomogram to Predict Benefit of Adjuvant Radiotherapy

Samuel J. Wang, MD, PhD; Snehal G. Patel, MD; Jatin P. Shah, MD; David P. Goldstein, MD; Jonathan C. Irish, MD, MSc, FRCSC; Andre L. Carvalho, MD, PhD; Luiz P. Kowalski, MD, PhD; Jennifer L. Lockhart, BSN; John M. Holland, MD; Neil D. Gross, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):554-559. doi:10.1001/jamaoto.2013.3001.
Text Size: A A A
Published online

Importance After surgical resection for oral cavity squamous cell carcinoma, adjuvant radiotherapy may be recommended for patients at higher risk for locoregional recurrence, but it can be difficult to predict whether a particular patient will benefit.

Objective To construct a model to predict which patients with oral cavity squamous cell carcinoma would benefit from adjuvant radiotherapy.

Design and Setting We constructed several types of survival models using a set of 979 patients with oral cavity squamous cell carcinoma. Covariates were age, sex, tobacco use, stage, grade, margins, and subsite. The best performing model was externally validated on a set of 431 patients.

Participants The model was based on a set of 979 patients with oral cavity squamous cell carcinoma, including 563 from Memorial Sloan Kettering Cancer Center, New York, New York, and 416 from the Hospital AC Camargo, São Paulo, Brazil. The validation set consisted of 431 patients from Princess Margaret Hospital, Toronto, Ontario, Canada.

Main Outcome and Measure The primary outcome measure of interest was locoregional recurrence-free survival.

Results The lognormal model showed the best performance per the Akaike information criterion. An online nomogram was built from this model that estimates locoregional failure-free survival with and without postoperative radiotherapy.

Conclusions and Relevance A web-based nomogram can be used as a decision aid for adjuvant treatment decisions for patients with oral cavity squamous cell carcinoma.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Kaplan-Meier plot of locoregional recurrence-free survival for all cases, grouped by T classification.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Comparison of lognormal survival model curve with actual Kaplan-Meier data for an example patient with T2N0 oral tongue cancer with positive margins.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Online prediction calculator that estimates the benefit of adjuvant radiotherapy for an individual patient. This web-based tool is available at http://skynet.ohsu.edu/nomograms.




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles