Calculator May Better Predict the Risk of Death for Patients With Oral Cancer

A newly developed calculator can predict the risk of cancer-specific and all-cause death for patients with oral cancer, according to research published in JAMA Otolaryngology-Head & Neck Surgery.¹

The publicly available calculator uses a patient-friendly interface to provide personalized estimates on oral cancer-specific death and all-cause death, according to researchers.

The calculator estimates the risk of death from oral cancer or death from other causes using 4 different models — a basic model that accounts for basic demographics, a model that also includes data on coexisting conditions, a model that also incorporates general health and smoking status, and a subjective assessment option that allows the user to manually modify the health status-adjusted age if they believe the calculator did not accurately capture the patients’ health status.

The models use data from the Surveillance, Epidemiology, and End Results (SEER) 18 registry (2000-2011), SEER-Medicare linked files, and the National Health Interview Survey (NHIS; 1986-2009).

The researchers tested the calculator on 22,392 patients with oral squamous cell carcinoma and 402,626 patients from the NHIS.

The calculator determined that noncancer survival was shorter in patients with oral squamous cell carcinoma than in the general population, and worse survival was associated with increasing stage of disease. For patients with stage III disease who survived to 50 years of age, an estimated 60% of women and 44% of men with oral cancer would be alive at age 70, as compared to 86% of women and 79% of men in the general population.

In patients aged 20-65 years, poorly differentiated or undifferentiated stage I-II oral squamous cell carcinoma was associated with a 2.7 times greater risk of death than a well-differentiated tumor. This risk was 3.0 times greater in patients aged 66-94 years.

Race and ethnicity were also associated with survival estimates. For an unmarried man aged 70 years with diabetes and stage I oral cancer that is poorly differentiated, the cumulative risk of cancer-specific death at 3 years is 11.1% if he is non-Hispanic White, 12.7% if he is non-Hispanic Asian or Pacific Islander, 14.5% if he is non-Hispanic Black, and 15.1% if he is Hispanic.

Although this calculator includes more personalized information than previous methods, the researchers acknowledged that some important variables could not be included due to the limitations of the databases used to build the models. These include tumor-specific information such as margin status, extracapsular tumor spread, and depth of invasion, as well as patient-specific information such as family and social support.

Authors of a related commentary noted that, although the calculator can provide valuable information, it is not intended to guide discussions about specific cancer treatments.²

“We do not yet have enough collective experience and longitudinal data to understand which patients may experience durable immunotherapy responses, flipping the switch from potentially lethal to chronic disease,” the commentary authors wrote. “As such, there is increasing recognition of quality beyond quantity of life as an important treatment outcome that has yet to be captured in current prediction calculators.”

References

1. Davies L, Hankey BF, Wang Z, et al. A new personalized oral cancer survival calculator to estimate risk of death from both oral cancer and other causes. JAMA Otolaryngol Head Neck Surg. Published online July 10, 2023. doi:10.1001/jamaoto.2023.1975

2. Mady LJ, Koch WM, Fakhry C. Novel oral cancer survival calculator—do we have a crystal ball? JAMA Otolaryngol Head Neck Surg. Published online July 10, 2023. doi:10.1001/jamaoto.2023.1976

This article originally appeared on Cancer Therapy Advisor