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@ARTICLE{Rhle:177229,
      author       = {A. Rühle$^*$ and C. Stromberger and E. Haehl$^*$ and C.
                      Senger and A. E. Falkenstein and R. G. Stoian$^*$ and C.
                      Zamboglou$^*$ and A. Knopf and V. Budach and A. L. Grosu$^*$
                      and N. Nicolay$^*$},
      title        = {{D}evelopment and {E}xternal {V}alidation of a {P}rognostic
                      {C}lassifier for {E}lderly {H}ead-and-{N}eck {C}ancer
                      {P}atients {U}ndergoing ({C}hemo)radiation.},
      journal      = {International journal of radiation oncology, biology,
                      physics},
      volume       = {111},
      number       = {3S},
      issn         = {0360-3016},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2021-02363},
      pages        = {e378},
      year         = {2021},
      note         = {#EA:E055#LA:E055#},
      abstract     = {Elderly head-and-neck squamous cell carcinoma (HNSCC)
                      patients form a heterogeneous cohort, and survival
                      estimation is often challenging due to underlying
                      comorbidities. Prognostic classifiers and nomograms may
                      therefore be useful for overall survival (OS) estimation in
                      order to provide shared decision-making in the clinical
                      routine.A total of 284 elderly HNSCC patients aged ≥65
                      years who received a curative (chemo)radiation between 2010
                      and 2020 at a tertiary cancer center were used for the
                      development of a survival classifier. On the basis of a
                      multivariate Cox regression analysis, significant parameters
                      were identified for which points were given according to the
                      beta regression values. The derived classifier was then
                      validated in a second, external cohort consisting of 217
                      elderly HNSCC patients undergoing (chemo)radiation. Based on
                      the cumulative data of 501 patients, a nomogram for the
                      2-year and 4-year OS was created. We then examined in a
                      third independent cohort whether the classifier could also
                      stratify the prognosis of surgically treated elderly HNSCC
                      patients without adjuvant (chemo)radiation (n = 169).In the
                      multivariate backward stepwise Cox regression with
                      likelihood ratio tests using P < 0.1 as inclusion criterion,
                      the Karnofsky Performance Status (KPS, HR = 2.654, P <
                      0.001), the age-adjusted Charlson Comorbidity Index (CCI, HR
                      = 2.598, P < 0.001) and the pre-radiotherapy CRP serum
                      concentration (HR = 1.634, P = 0.064) were significant
                      prognostic parameters for OS. Following the beta regression
                      values, a KPS $≤70\%$ and a CCI ≥6 points were given 1
                      point, while a CRP concentration ≥5 mg/L was given 0.5
                      points. The median OS was 107 (0 points), 34 (0.5 points),
                      28 (1 point), 11 (1.5 points), 9 (2 points) and 6 months
                      (2.5 points), respectively. In order to obtain considerably
                      distinct prognostic subgroups, 3 prognostic groups were
                      created: A favorable (0 points), an intermediate (0.5-2
                      points) and a poor (2.5 points) subgroup. While the median
                      OS for the favorable group amounted to 107 months, it was 28
                      and 6 months for the intermediate and poor cohorts,
                      respectively (P < 0.001, log-rank test). In the external
                      cohort, the median OS was found to range at 130, 29 and 9
                      months for the favorable, intermediate and poor group,
                      respectively (P = 0.005). Using the aggregated data of both
                      cohorts, a nomogram based on the KPS, CCI and CRP was
                      created for the 2-year and 4-year OS that exhibited a
                      concordance index of 0.65 (Harrell's C). For the surgically
                      treated cohort of elderly HNSCC patients, only the KPS
                      $≤70\%$ (HR = 5.950, P = 0.002) but not the CCI ≥6
                      points (HR = 1.937, P = 0.232) or the baseline CRP serum
                      value (HR = 1.743, P = 0.328) were significant
                      prognosticators.We developed and externally validated a
                      clinically feasible survival score for elderly HNSCC
                      patients undergoing (chemo)radiation. Both the score and
                      nomogram may be useful aiding shared decision-making of
                      radiation oncologists and medical oncologists treating
                      elderly HNSCC patients.},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34701311},
      doi          = {10.1016/j.ijrobp.2021.07.1110},
      url          = {https://inrepo02.dkfz.de/record/177229},
}