TY - JOUR
T1 - Clinical-severity staging system for oral cavity cancer
T2 - Five-year survival rates
AU - Pugliano, F. A.
AU - Piccirillo, J. F.
AU - Zequeira, M. R.
AU - Fredrickson, J. M.
AU - Perez, C. A.
AU - Simpson, J. R.
N1 - Funding Information:
Supported in part by the AAO-HNS Academy Research Training Award (F.A.P.), the American Cancer Society Junior Clinical Research Award (JCA1) (J.F.P.), and the National Cancer Institute (R01 CA62072) (J.F.P.).
PY - 1999
Y1 - 1999
N2 - The objective of this research is to improve the classification and survival estimates for patients with oral cavity cancer by combining cancer symptom severity and comorbidity with the current TNM staging system. The study design is a retrospective medical record review that uses explicit coding criteria. The medical records of 277 patients receiving initial treatment at the Washington University Medical Center between 1980 and 1989 were reviewed. Multivariate analysis identified patient factors that significantly affected 5-year survival. These patient factors, symptom severity and comorbidity, were combined with TNM to create a composite clinical-severity staging system. The overall 5-year survival rate was 46% (128/277). Survival rates by TNM stage were as follows: stage I, 72% (36/50); II, 54% (45/84); III, 37% (24/65); and IV, 29% (23/78) (χ2 = 25.27, P = 0.001). When patients were grouped according to the clinical-severity staging system, survival rates were as follows: stage I, 77% (33/43); II, 56% (45/80); III, 42% (43/103); and IV, 14% (7/51) (χ2 = 40.62, P= 0.001). Survival estimates can be improved by adding carefully studied and suitably derided patient variables to the TNM system. The current TNM staging system for oral cavity cancer is based solely on the morphologic description of the tumor and disregards the clinical condition of the patient. Patient factors, such as cancer symptom severity and comorbidity, have a significant impact on survival. Continued exclusion of patient factors leads to imprecision in prognostic estimates and hinders interpretation of clinical studies.
AB - The objective of this research is to improve the classification and survival estimates for patients with oral cavity cancer by combining cancer symptom severity and comorbidity with the current TNM staging system. The study design is a retrospective medical record review that uses explicit coding criteria. The medical records of 277 patients receiving initial treatment at the Washington University Medical Center between 1980 and 1989 were reviewed. Multivariate analysis identified patient factors that significantly affected 5-year survival. These patient factors, symptom severity and comorbidity, were combined with TNM to create a composite clinical-severity staging system. The overall 5-year survival rate was 46% (128/277). Survival rates by TNM stage were as follows: stage I, 72% (36/50); II, 54% (45/84); III, 37% (24/65); and IV, 29% (23/78) (χ2 = 25.27, P = 0.001). When patients were grouped according to the clinical-severity staging system, survival rates were as follows: stage I, 77% (33/43); II, 56% (45/80); III, 42% (43/103); and IV, 14% (7/51) (χ2 = 40.62, P= 0.001). Survival estimates can be improved by adding carefully studied and suitably derided patient variables to the TNM system. The current TNM staging system for oral cavity cancer is based solely on the morphologic description of the tumor and disregards the clinical condition of the patient. Patient factors, such as cancer symptom severity and comorbidity, have a significant impact on survival. Continued exclusion of patient factors leads to imprecision in prognostic estimates and hinders interpretation of clinical studies.
UR - http://www.scopus.com/inward/record.url?scp=0032900288&partnerID=8YFLogxK
U2 - 10.1016/S0194-5998(99)70367-0
DO - 10.1016/S0194-5998(99)70367-0
M3 - Article
C2 - 9914547
AN - SCOPUS:0032900288
SN - 0194-5998
VL - 120
SP - 38
EP - 45
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 1
ER -