DEVELOPMENT OF A NEW STAGING SYSTEM FOR PATIENTS WITH RECURRENT LARYNGEAL SQUAMOUS-CELL CARCINOMA

BACKGROUND. The management of recurrent head and neck squamous cell ca rcinoma can be challenging to both physician and patient. This is due at least in part to the lack of an accurate and clinically applicable staging system for these patients. The purposes of this study were to examine the survival patterns of patients presenting with recurrent la ryngeal tumors, identify key factors affecting prognosis, and combine these factors to create a new staging system to predict survival. METH ODS. The methods included a retrospective chart review of 473 patients with laryngeal squamous cell carcinoma who received their initial tre atment at Washington University between 1980 and 1992. From this popul ation, 126 patients (27%) who developed recurrence were identified. RE SULTS. The overall 2-year survival rate was 40% (50 of 124 patients). Four variables affected survival: initial TNM stage, initial treatment , morphologic extent of recurrence, and treatment of recurrence. These variables were entered into a multivariate analysis to determine inde pendent prognostic significance. Three variables were found to be stat istically significant: TNM stage (chi-square = 4.6; P = 0.03), initial treatment (chi-square = 14.3; P = 0.0002), and extent of recurrence ( chi-square = 19.4; P = 0.0001). The process of conjunctive consolidati on was used to combine significant variables to create a new staging s ystem for laryngeal recurrence. CONCLUSIONS, This staging system provi des accurate estimates of prognosis, involves no new technology to imp lement, can aid both the patient and physician in planning treatment, and can be used in observational studies to assess the relative effect iveness of competing therapies. (C) 1998 American Cancer Society.