T-STAGE AND FUNCTIONAL OUTCOME IN ORAL AND OROPHARYNGEAL CANCER-PATIENTS

Background. The locus and extent of resection and the type of reconstr uction used in surgery are important joint determinants of functional outcome in oral and oropharyngeal cancer patients. However, prediction of functional outcome from broader factors such as clinical T stage a nd approximate locus of resection is important for the preoperative pe riod when the extent of resection and the exact surgical reconstructio n to be used may not be decided and preoperative counseling about pote ntial functional outcomes is needed. Methods. Oropharyngeal swallow ef ficiency (OPSE) and conversational speech understandability (CU) were measured preoperatively and 3 months posthealing in 68 patients. Analy sis of variance (ANOVA) was used to determine whether clinical T stage and planned surgical locus were significantly related to these two fu nctional measures, and discriminant analysis was used on the data obta ined at 3 months to determine how well CU and liquid OPSE jointly rela te to the T stages. Results. In patients with a planned oral tongue lo cus of resection, significant differences were found at 3 months posth ealing on both CU and liquid OPSE between stages T1-T2 and T3 and betw een T1-T2 and T4, In patients with a planned oropharynx locus of resec tion, significant differences were found only on CU at 3 months. These occurred between T1-T2 and T4 and between T3 and T4. Discriminant ana lysis classified into the correct T stages 70% of T1-T2 and 75% of T4 stage patients, but only 28% of T3 stage patients. However, the TB-sta ge patients who were misclassified as T4 had significantly larger mean percent of oral tongue resected than those T3 stage patients who were misclassified as T1-T2. Conclusions. These results are useful for the preoperative counseling of patients with clinical T stages 1-2 and 4. The relationship between T stage and postsurgical function found here is stronger than reported by previous authors, but is still very gene ral.