COMPARISON OF THE ADDITION OF T-INTEGER AND N-INTEGER SCORES WITH TNMSTAGE GROUPS IN HEAD AND NECK-CANCER

The 1987 TNM classification system modified T and N definitions for sq uamous cell carcinomas of the head and neck. It did not change stage g roupings (I through IV). The primary purpose of clinical staging is to divide patients into prognostically meaningful groups. The 1987 chang es to the TNM T and N descriptions may not have removed the previously established heterogeneity within stage groups III and IV which existe d before 1987. The development of a stage grouping system called TANIS (the T And N Integer Score), which is formed by adding the integer va lues of the T and N classifications, is reported herein. We compared t he prognostic performance of T, N, TNM stage group, and TANIS stage fo r radiotherapy response and survival using data from 86 patients with newly diagnosed, measurable TNM II (oral cavity), and localized TNM II I-IV squamous cell carcinomas of the head and neck, excluding nasophar ynx, who were randomized to test 5-fluorouracil-methotrexate sequencin g. The sequencing of chemotherapy was shown to make no difference to p rognosis. All patients received 60 Gy of radiotherapy in 6 weeks. As c ompared to T, N, and the TNM stage group system, TANIS was the single best predictor for a complete response to radiotherapy (p = 0.0005). T ANIS was also the single best predictor for survival from randomizatio n (p = 5 x 10(-6)). With the 86 patients divided into three groups (TA NIS 2 to 3, 4, and 5 to 7), TANIS provided a better prognostic discrim ination than did the TNM stage grouping method (TNM II, III, and IV). TANIS is a single index that combines T and N information in a simple way which was more strongly associated with radiotherapy response and survival than the traditional TNM stage groups. (C) 1993 John Wiley & Sons, Inc.