title: A model and nomogram to predict tumor site origin for squamous cell cancer confined to cervical lymph nodes.
abstract: BACKGROUND
  The current study was conducted to develop a multifactorial statistical model to predict the specific head and neck (H&N) tumor site origin in cases of squamous cell carcinoma confined to the cervical lymph nodes ("unknown primaries").
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for patients with an H&N tumor site who were diagnosed between 2004 and 2011. The SEER patients were identified according to their H&N primary tumor site and clinically positive cervical lymph node levels at the time of presentation. The SEER patient data set was randomly divided into 2 data sets for the purposes of internal split-sample validation. The effects of cervical lymph node levels, age, race, and sex on H&N primary tumor site were examined using univariate and multivariate analyses. Multivariate logistic regression models and an associated set of nomograms were developed based on relevant factors to provide probabilities of tumor site origin.
  
  
  RESULTS
  Analysis of the SEER database identified 20,011 patients with H&N disease with both site-level and lymph node-level data. Sex, race, age, and lymph node levels were associated with primary H&N tumor site (nasopharynx, hypopharynx, oropharynx, and larynx) in the multivariate models. Internal validation techniques affirmed the accuracy of these models on separate data.
  
  
  CONCLUSIONS
  The incorporation of epidemiologic and lymph node data into a predictive model has the potential to provide valuable guidance to clinicians in the treatment of patients with squamous cell carcinoma confined to the cervical lymph nodes.
authors: Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Arif N
authors: AN
authors: Ali
authors: Jeffrey M
authors: JM
authors: Switchenko
authors: Sungjin
authors: S
authors: Kim
authors: Jeanne
authors: J
authors: Kowalski
authors: Mark W
authors: MW
authors: El-Deiry
authors: Jonathan J
authors: JJ
authors: Beitler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D049451:Nomograms; D018426:SEER Program; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: End Results (SEER); Epidemiology; Surveillance; cervical lymph nodes; predictive model; radiation; unknown primary