Nomogram Identifies Age as the Most Important Predictor of Overall Survival in Oral Cavity Squamous Cell Cancer After Primary Surgery

  • Supriya GuptaEmail author
  • Jennifer Waller
  • Jimmy Brown
  • Yolanda Elam
  • James V. Rawson
  • Darko Pucar
Original Article


Our goal was to determine the most important predictors and construct a nomogram for overall survival (OS) in oral cavity squamous cell cancer (OCSCC) treated with primary surgery followed by observation, adjuvant radiation or chemoradiation. Multivariable analysis was performed using Cox Proportional Hazard model of 9258 OCSCC patients from Surveillance, Epidemiology and End Results Program (SEER) database treated with surgery from 2003 to 2009. Potential predictors of OS were age, gender, race, tobacco use, oral cancer sub-sites, pathologic tumor stage and grade, pathologic nodal stage, extra-capsular invasion, clinical levels IV and V involvement, and adjuvant treatment selection. Weighted propensity scores for treatment were used to balance observed baseline characteristics between three treatment groups in order to reduce bias. Following primary surgery, patients underwent observation (56%), radiation alone (31%) or chemoradiation (13%). All tested predictors were statistically significant and included in our final nomogram. Most important predictor of OS was age, followed by pathologic tumor stage. SEER based-survival nomogram for OCSCC patients differs from published models derived from patients treated in a single or few academic treatment centers. An unexpected finding of patient age being the best OS predictor suggests that this factor may be more critical for the outcome than previously anticipated.


Oral cavity Squamous cell cancer Nomogram Survival Age 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Amita Presence St. Mary’s HospitalKankakeeUSA
  2. 2.Augusta University Medical CenterAugustaUSA
  3. 3.Beth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  4. 4.Yale University Medical CenterNew HavenUSA

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