Development of a prediction model for tube feeding dependence in HPV-associated oropharyngeal cancer patients undergoing chemoradiotherapy.

Abstract

Objectives: This study aimed to develop a prediction model for feeding tube dependence in a large homogenous cohort of HPV-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) patients receiving chemoradiotherapy (CRT). We further aimed to externally validate three previously published feeding tube prediction models on this cohort.

Materials and methods: p16-confirmed HPV + OPSCC patients treated with definitive CRT at a tertiary cancer centre between April 2017 and February 2022 were identified. The primary endpoint was G-tube dependence, defined as enteral feeding for ≥ 4 weeks following CRT. Clinical and dosimetric data were extracted from electronic patient records. Multivariable analyses (MVA) assessed the associations of potential predictors with G-tube dependence. The discriminatory performance of three previously published models was assessed on this cohort using the area under the receiver operating curve (AUC), and calibration was evaluated with calibration plots.

Results: A total of 291 patients were included (TNM8 stage I: 129; II:67; III: 95). MVA identified Dmean to the superior pharyngeal constrictor muscle, D70% to the middle pharyngeal constrictor muscle, and modified diet texture at baseline as predictive for G-tube dependence, with the AUC of 0.68. External validation of three existing models yielded an AUC of 0.60, 0.63, and 0.67, with no evidence of good calibration.

Conclusion: Despite a sizable cohort and comprehensive capture of dosimetric information, our prediction model, and external validation of previously published models, showed moderate performance. This suggests that additional factors beyond disease and treatment may need to be considered in future models to refine nutrition support decisions.