Clinical-severity staging system for oral cavity cancer: Five-year survival rates

The objective of this research is to improve the classification and surviva l estimates for patients with oral cavity cancer by combining cancer sympto m severity and comorbidity with the current TNM staging system. The study d esign is ct retrospective medical record review that uses explicit coding c riteria. The medical records of 277 patients receiving initial treatment at the Washington University Medical Center between 1980 and 1989 were review ed. Multivariate analysis identified patient factors that significantly aff ected 5-year survival. These patient factors, symptom severity and comorbid ity, 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) (chi(2) = 25.27, P = 0.001). When patients were grouped according to the clinical-severity staging system, survival r ates were as follows: stage I, 77% (33/43); II, 56% (45/80); III, 42% (43/1 03); and IV, 14% (7/51) (chi(2) = 40.62, P = 0.001). Survival estimates can be improved by adding carefully studied and suitably defined patient varia bles to the TNM system. The current TNM staging system for oral cavity canc er is based solely on the morphologic description of the tumor and disregar ds the clinical condition of the patient. Patient factors, such as cancer s ymptom severity and comorbidity, have a significant impact on survival. Con tinued exclusion of patient factors leads to imprecision in prognostic esti mates and hinders interpretation of clinical studies.