A Nomogram based prognostic score that is superior to conventional TNM staging in predicting outcome of surgically treated T4 buccal mucosa cancer: Time to think beyond TNM.

BACKGROUND AND

OBJECTIVES

T4 squamous cell carcinomas of the buccal mucosa is known to have ominous outcome. The aim of this study was to develop a nomogram for T4 buccal mucosa cancer patients and demonstrate the difference in survival based on prognosticators beyond those covered by the traditional TNM staging system.

METHODS

We examined medical records of treatment naïve 205 T4 buccal mucosa cancer patients operated between January 1, 2009, and December 31, 2014. A nomogram was developed using multivariate cox-regression. The nomogram was validated internally by bootstrapping and externally in an independent validation set.

RESULTS

The nomogram for predicting 3-year overall survival was built using Tumor differentiation, Pathological Lymph node involvement, Bone and Perineural invasion. Based on nomogram, a score was assigned to each patient and they were divided into two groups based on Youden derived cut-off value (13.5). These two groups in training and validation set showed significant difference in survival.

CONCLUSION

We developed a high performance, accurate and efficient nomogram to predict the probability of 3-year survival in T4 buccal mucosa cancer patients. Intensification of adjuvant treatment in these advanced cancer patients with poorer score might improve their survival.