CLINICAL STAGING OF OROPHARYNGEAL CARCINOMA - A CRITICAL-EVALUATION OF A NEW STAGE GROUPING PROPOSAL

BACKGROUND. An alternative to the International Union Against Cancer/A merican Joint Committee on Cancer (UICC/AJCC) stage grouping system wa s proposed for patients with oropharyngeal carcinoma by Hart et al. (1 995) on behalf of the Dutch Head and Neck Oncology Cooperative Group. The system was created by regrouping the T, N, and M categories withou t redefining the categories themselves. METHODS. Data related to epide miology, treatment, and survival from 224 previously untreated patient s with oropharyngeal carcinoma were analyzed. Staging was performed ac cording to the 1992 UICC/AJCC criteria and according to the proposed s tage grouping system. Kaplan-Meier estimates of overall survival were compared for both staging systems; and in a Cox proportional hazards r egression analysis, the influence of the variables age, gender, subsit e and side of tumor location, histopathologic grade, form of treatment , and stage distribution (according to 1992 UICC criteria and that pro posed by Hart et al.) on overall survival was determined. RESULTS. The proposed staging system showed a more balanced distribution of patien ts (16% in Stage I, 37% in Stage II, 14% in Stage III, and 33% in Stag e IV compared with 5% in Stage I, 7% in Stage II, 21% in Stage III, an d 67% in Stage IV according to UICC/AJCC 1992 staging). Furthermore, t he proposed staging system showed better prognostic discrimination for overall survival (5-year survival rates according to the staging syst em of Hart et al. were 59% in Stage I, 31% in Stage II, 28% in Stage I II, and 16% in Stage IV, vs. 61% in Stage I, 59% in Stage II, 32% in S tage III, and 24% in Stage IV according to UICC/AJCC 1992 staging). CO NCLUSIONS. The results are in concordance with the results published b y the Dutch Head and Neck Oncology Cooperative Group. It is possible t o improve the current staging system by regrouping the T, N, and M cat egories. [See editorial on pages 1611-2, this issue.] (C) 1998 America n Cancer Society.