Risk Stratification for Trial Enrichment Considering Loco-Regional Failure in Head and Neck Cancer: UICC8 Versus Purpose-Built Failure-Type Specific Risk Prediction Model.

Abstract

A previously published failure-type specific risk model showed good performance in the original cohort. to validate the model and separate patients with high- and low-risk loco-regional failure (LRF). to identify patients potentially suitable for treatment intensification trials. Validation data: 756 patients from two institutions (different countries). Predictive performance was evaluated by Brier scores and AUCs. Discriminatory performance was compared to Union for International Cancer Control (UICC) staging (versions 7 and 8). The model's 3-year AUC for LRF was 65%, significantly better than UICC7 staging, but no significant difference to UICC8. Model-based risk stratification and UICC8 both identified high-risk patient groups with 3-year LRF ≈30%. The population mean was 18%. The model performed well on a group level. UICC8 staging performed equally well. Although developed for the endpoint of OS, an improvement from UICC version 7 to version 8 was evident also for the prediction of LRF.