Prognostic benefit of preoperative radiotherapy for patients with metastatic larynx and hypopharynx cancers and XGBoost-based prognostic models to predict their survival

BACKGROUND: To date, no study has systematically compared the prognostic benefit of preoperative radiation therapy (RT) and postoperative RT, RT alone, and surgery alone in this patient population. There is a clear clinical need for accurate survival prediction tools to address the concerns of both patients and clinicians. METHODS: Patients diagnosed with metastatic larynx and hypopharynx cancer (T1-2N1-3/T3-4 any N) were retrospectively analyzed. Cox regression was used to examine independent prognostic factors associated with overall survival (OS), propensity score matching (PSM) and Kaplan-Meier analysis were employed to compare survival outcomes between treatment groups. Finally, an extreme gradient boost (XGBoost) model was constructed to predict patient survival. RESULTS: A total of 18,988 eligible patients were included. PSM analyses showed that, compared with surgery alone, preoperative RT followed by surgery was associated with improved OS of patients with hypopharynx cancer (except pyriform sinus), those aged 70 years or older, and those who did not receive chemotherapy. The validation results show that our XGBoost model achieved an AUC value ranging from 0.716 to 0.745 on the test set and 0.759-0.805 on the external validation set. Feature importance evaluation and SHAP values indicated that sequence of RT and surgery, age at diagnosis, and N stage were the three most influential predictors. CONCLUSION: We conducted a comprehensive exploration of the clinicopathology characteristics of patients with metastatic larynx and hypopharynx cancer, and prognostic models were constructed to accurately predict their survival. These findings may help formulate individualized treatment strategies and potentially improve patient prognosis.