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Mitchell A. Medow, MD,PhD; Harrison G. Weed, MD; David E. Schuller, MD

Arch Otolaryngol Head Neck Surg. 2002;128:1282-1286.

Objective  To develop a simple prognostic survival rule from easily obtained characteristics of patients undergoing potentially curative resection of head and neck squamous cell carcinoma using classification and regression trees.

Design  Inception cohort.

Setting  Tertiary care center.

Patients  Consecutive patients undergoing resection lasting at least 2 hours, from July 1993 through June 1997.

Main Outcome Measure  Survival, age, TNM tumor stage, functional class, systolic and diastolic blood pressure, body mass index, and serum albumin concentration were evaluated as predictors.

Results  Four hundred six patients were followed up for 5 to 1446 days (median, 391 days), during which time 172 deaths occurred. Median survival was 687 days. Patients with TNM stage I, II, or III squamous cell carcinoma had a mean survival of 1068 days. Patients with TNM stage IV or recurrent disease were further stratified. Those with a serum albumin concentration less than 3.85 g/dL had a median survival of 404 days (95% confidence interval, 286-532 days), and those with an serum albumin concentration of 3.85 g/dL or above had a median survival of 625 days (95% confidence interval, 536-1032 days). A similar survival was found using age younger than 66.5 years as a predictor instead of serum albumin concentration less than 3.85 g/dL.

Conclusions  At our institution, patients with stage I, II, or III squamous cell carcinoma had a mean survival of approximately 3 years. Those with stage IV or recurrent squamous cell carcinoma could be stratified by either serum albumin concentration or by age into 2 groups with a median survival of 1 or 2 years.

From the Division of General Internal Medicine (Drs Medow and Weed) and the Department of Otolaryngology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (Dr Schuller), The Ohio State University College of Medicine and Public Health, Columbus.

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