CLINICAL-SEVERITY STAGING SYSTEM FOR OROPHARYNGEAL CANCER - 5-YEAR SURVIVAL RATES

Objective: To improve the classification and survival estimates for pa tients with oropharyngeal cancer by combining cancer symptom severity and comorbidity with the current TNM cancer staging system. Design: Re trospective medical record review using explicit coding criteria. Sett ing: University medical center. Patients and Methods: Two hundred nine ty-six patients receiving initial treatment from January 1, 1980, to D ecember 31, 1989. Multivariate analysis identified patient factors tha t had a significant impact on 5-year survival. These patient factors, symptom severity and comorbidity, were combined with cancer stage to c reate a composite clinical-severity staging system. Main Outcome Measu rer Five-year survival. Results: The overall 5-year survival rate was 38% (111/ 296). Survival by TNM cancer stage was 67% (18/27) for stage I, 46% (24/52) for stage II, 31% (26/85) for stage III, and 32% (43/1 32) for stage IV (chi(2)=10.84; P=.001). When patients were grouped ac cording to the clinical severity staging system, survival rates were 7 0% (16 of 23) for stage A, 47% (71 of 152) for stage B, 27% (18 of 67) for stage C, and 11% (6 of 54) for stage D (chi(2)=34.49; P=.001). Co nclusions: Survival estimates can be improved by adding carefully stud ied and suitably defined patient variables to the TNM cancer stage. Th e current TNM cancer staging system for oropharyngeal cancer is based solely on the morphologic description of the tumor and disregards the clinical condition of the patient. Cancer symptom severity and comorbi dity have a significant impact on survival. Continued exclusion of pat ient factors leads to imprecision in prognostic estimates and hinders interpretation of clinical studies.