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Prognostic Staging System for Recurrent, Persistent, and Second Primary Cancers of the Oral Cavity and Oropharynx
Bevan Yueh, MD;
Alvan R. Feinstein, MD, MS;
Edward M. Weaver, MD;
Clarence T. Sasaki, MD;
John Concato, MD, MS, MPH
Arch Otolaryngol Head Neck Surg. 1998;124:975-981.
Objective To develop a practical staging system for predicting mortality of patients with recurrent squamous cell tumors of the oral cavity and oropharyngeal mucosa.
Design and Setting An inception cohort at an academic medical center.
Patients A total of 308 patients who had evidence of recurrent, persistent, or second primary tumors of the oral cavity and oropharynx between January 1, 1980, and December 31, 1991, of whom 162 (52.6%) met inclusion criteria.
Main Outcome Measure One-year mortality.
Results The median survival time was 10 months. In bivariate analysis, the TNM stage of the recurrent tumor, invasion of pharyngeal constrictors and the floor-of-mouth muscles, weight loss, local and systemic symptoms, and eating function had significant effects on mortality. Multivariable analysis (done by conjunctive consolidation and Cox regression) identified constrictor invasion, the TNM stage of the recurrence, and weight loss as having a substantial effect on mortality. A composite 4-stage system using these 3 variables demarcated 1-year survival rates of 88.2% (30/34), 71.9% (23/32), 32.6% (16/49), and 4.2% (2/47).
Conclusions The TNM status of recurrent tumors predicts mortality, but constrictor muscle invasion and weight loss also have major prognostic importance. The consolidation of these variables into a composite staging system successfully stratifies patients with widely divergent mortality rates. Improved staging of recurrent head and neck tumors can lead to more effective decisions about the comparisons and merits of additional treatment.
From the Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, and the Surgery Service, Veterans Affairs Puget Sound Health Care System, Seattle, Wash (Dr Yueh); the Section of General Medicine, Department of Internal Medicine (Drs Feinstein and Concato), and the Section of Otolaryngology, Department of Surgery (Drs Weaver and Sasaki), Yale University School of Medicine, New Haven, Conn; and the Medical Service, Veterans Affairs Connecticut Health Care System, West Haven (Dr Concato).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
A Critical Evaluation of Critical Pathways in Head and Neck Cancer
Yueh et al.
Arch Otolaryngol Head Neck Surg 2003;129:89-95.
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