PROGNOSTIC STAGING SYSTEM FOR RECURRENT, PERSISTENT, AND 2ND PRIMARY CANCERS OF THE ORAL CAVITY AND OROPHARYNX

Objective: To develop a practical staging system for predicting mortal ity of patients with recurrent squamous cell tumors of the oral cavity and oropharyngeal mucosa. Design and Setting: An inception cohort at an academic medical center. Patients: A total of 308 patients who had evidence of recurrent, persistent, or second primary tumors of the ora l cavity and oropharynx between January 1, 1980, and December 31, 1991 , of whom 162 (52.6%) met inclusion criteria. Main Outcome Measure: On e-year mortality. Results: The median survival time was 10 months. In bivariate analysis, the TNM stage of the recurrent tumor, invasion of pharyngeal constrictors and the floor-of-mouth muscles, weight loss, l ocal and systemic symptoms, and eating function had significant effect s on mortality. Multivariable analysis (done by conjunctive consolidat ion and Cox regression) identified constrictor invasion, the TNM stage of the recurrence, and weight loss as having a substantial effect on mortality. A composite 4-stage system using these 3 variables demarcat ed 1-year survival rates of 88.2% (30/34), 71.9% (23/32), 32.6% (16/49 ), and 4.2% (2/47). Conclusions: The TNM status of recurrent tumors pr edicts mortality, but constrictor muscle invasion and weight loss also have major prognostic importance. The consolidation of these variable s into a composite staging system successfully stratifies patients wit h widely divergent mortality rates. Improved staging of recurrent head and neck tumors can lead to more effective decisions about the compar isons and merits of additional treatment.