Development and validation of prognostic models for oral squamous cell carcinoma: A systematic review and appraisal of the literature

Abstract

(1) Background: An accurate prediction of cancer survival is very important for counseling, treatment planning, follow-up, and postoperative risk assessment in patients with Oral Squamous Cell Carcinoma (OSCC). There has been an increased interest in the development of clinical prognostic models and nomograms which are their graphic representation. The study aimed to revise the prognostic performance of clinical-pathological prognostic models with internal validation for OSCC. (2) Methods: This systematic review was performed according to the Cochrane Handbook for Diagnostic Test Accuracy Reviews chapter on searching, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). (3) Results: Six studies evaluating overall survival in patients with OSCC were identified. All studies performed internal validation, while only four models were externally validated. (4) Conclusions: Based on the results of this systematic review, it is possible to state that it is necessary to carry out internal validation and shrinkage to correct overfitting and provide an adequate performance for optimism. Moreover, calibration, discrimination and nonlinearity of continuous predictors should always be examined. To reduce the risk of bias the study design used should be prospective and imputation techniques should always be applied to handle missing data. In addition, the complete equation of the prognostic model must be reported to allow updating, external validation in a new context and the subsequent evaluation of the impact on health outcomes and on the cost-effectiveness of care.