A Novel Nomogram Based on the Fibrinogen and Platelet-to-lymphocyte Ratio Is Associated With Overall Survival in Oral Squamous Cell Carcinoma

BACKGROUND: Previous studies suggested inflammation and coagulation were associated with cancer prognosis. PURPOSE: The purpose was to measure the association between the combining inflammation and coagulation (CIC) index and the prognosis oral squamous cell carcinoma (OSCC) patients, and to construct a nomogram to estimate the survival estimation capability of CIC index on the overall survival (OS). STUDY DESIGN, SETTING, AND SAMPLE: A retrospective cohort study was performed at the Beijing Stomatological Hospital, Capital Medical University, including OSCC patients treated between 2017 and 2019 who underwent at least 5-year follow-up. Patients with history of radiotherapy/recurrence, other malignancies, preoperative infection/hematopoietic diseases, or unmet surgical indications were excluded. PREDICTOR VARIABLE: The predictor variable was the CIC index, calculated by multiplying the platelet-to-lymphocyte ratio by fibrinogen level before treatment. MAIN OUTCOME VARIABLE: The primary outcome variable was 3-year and 5-year OS. Secondary outcome variable was disease recurrence during the follow-up period. COVARIATES: Covariates included age, sex, TNM stage, smoking and drinking history, postoperative radiotherapy, Eastern Cooperative Oncology Group performance status, flap repair and oral cavity sites. ANALYSES: All subjects were divided into the training cohort and the validation cohort. The training cohort was used to perform univariate and multivariate Cox regression analyses, and constructed the nomogram. The validation cohort was used to verify the survival estimation ability of the nomogram through area under the receiver operating curve. RESULTS: The sample included 160 subjects, the mean ± SD of age was 58 ± 10.92 years and 84 (52.5%) was males. The median (interquartile range) for follow-up was 62 (35 to 75) months. Multivariate Cox regression model showed CIC (hazard ratio (HR):3.19, P < .05, 95% CI: 1.43 to 7.12) and TNM stage (HR: 1.86, P < .01,95% CI: 1.36 to 2.54) were associated the OS of OSCC. Additionally, CIC was associated with OSCC recurrence (HR: 2.38, P < .05, 95% CI: 1.17 to 4.83). The area under the receiver operating characteristic curve value for OS in the training and validation cohorts were 0.75 and 0.80, respectively, indicating excellent discriminatory ability. Calibration curves confirmed the nomogram's accuracy, and decision curve analysis showed good clinical applicability of the nomogram. CONCLUSIONS AND RELEVANCE: CIC is a promising OSCC prognostic index, and the nomogram may assist physicians with individualized treatment to improve patient survival in the future.