Developing a predictive nomogram and web-based survival calculator for Locally Advanced hypopharyngeal cancer: A Propensity Score-Adjusted, Population-Based Study

Abstract Background: Patients with locally advanced hypopharyngeal squamous cell carcinoma (LA-HPSCC) face poor survival with no consensus on optimized therapies. Understanding the clinical features and treatments for the disease is important for patient centered decision-making. This study aims to create a multi-factor nomogram predictive model and web-based calculator to predict post-therapy survival for patients with LA-HPSCC. Methods: A retrospective cohort study analyzing Surveillance, Epidemiology, and End Results (SEER) database from 2004-to-2015 for patients diagnosed with LA-HPSCC was conducted and randomly divided into training and validation groups (7:3 ratio). The external validation cohort included 276 patients from Sichuan Cancer Hospital, China. Univariate and multivariate Cox-proportional-hazards regressions were used to identify independent factors associated with overall survival (OS) and cancer-specific survival (CSS), and nomogram models and web-based survival calculators were constructed. Propensity score matching (PSM) were used to compare survival with different treatment options. Results: A total of 2526 patients were included in the prognostic model. The median OS and CSS for the entire cohort were 20 (18.6-21.3) months and 24 (21.7-26.2) months, respectively. Nomogram models integrating the seven factors demonstrated high predictive accuracy for 3-year and 5-year survival. PSM found that patients who received surgery-based curative therapy had better OSand CSS than those who received radiotherapy-based treatment (median survival times: 33 months vs. 18 months and 40 months vs. 22 months, respectively). Conclusions: The nomogram model accurately predicted patient survival from LA-HPSCC. Surgery with adjuvant therapy yielded significantly better survival than definitive radiotherapy and should be prioritized for survival.