Background: The prognosis of patients with recurrent tumors of the head and neck generally is considered poor. Better prediction of outcomes can help physicians counsel patients about the merits of additional treatment. The TNM system, which was created for patients with primary tumors, may not provide optimal information. Anatomic staging systems traditionally have ignored symptom-based variables, such as weight loss, despite their known prognostic value. The objectives of this study were 1) to measure the prognostic impact of weight loss, 2) to evaluate the prognostic value of the TNM staging system, and 3) to create a practical staging system capable of predicting survival after patients develop recurrent tumors of the oral cavity and oropharynx.
Methods: A retrospective chart review was used to identify an inception cohort of patients seeking treatment for recurrent, persistent, and second primary tumors of the oral cavity and oropharynx at the University of Washington. The primary outcome variable was 1-year survival.
Results: The 1-year survival rate for the cohort (n = 97 patients) was 38%, with a median survival of 0.7 years. Multivariate analysis (Cox regression) identified weight loss, previous radiation to the head and neck, and TNM stage of the recurrent tumor as factors that had a substantial impact on mortality. A second multivariate technique called conjunctive consolidation was used to determine the relative quantitative impact of each variable on survival and to develop a clinical staging system. Weight loss and previous radiation had the greatest influence, and the use of just these two variables resulted in a three-tiered staging system with 1-year survival rates of 62% (16 of 26 patients), 44% (18 of 41 patients), and 10% (3 of 30 patients). In contrast, the TNM staging system produced survival rates of 60% (patients with Stage I disease), 67% (patients with Stage II disease), 32% (patients with Stage III disease), and 32% (patients with Stage IV disease).
Conclusions: The authors found substantial variation in survival after patients developed recurrent tumors of the oral cavity and oropharynx. Two readily available clinical variables--weight loss and previous radiation--were combined to create a clinically practical staging scheme with more prognostic power than the TNM staging system. Until molecular markers can reliably used be to predict outcomes, greater attention needs to be given to the utility of simple, inexpensive, and surprisingly powerful clinical variables.
Copyright 2002 American Cancer Society.