EVALUATION OF THE NEWLY UPDATED TNM CLASSIFICATION OF HEAD AND NECK-CARCINOMA WITH DATA FROM 3247 PATIENTS

BACKGROUND. The fifth edition of the TNM classification contains a num ber of changes concerning head and neck tumors. The division of Stage IV tumors into three subcategories marks a significant expansion of th e stage grouping procedure. METHODS. In a retrospective study, the cli nical courses of 3247 patients with carcinoma of the oral cavity, the oro- and hypopharynx, the larynx, the salivary glands, and the maxilla ry sinus were comparatively evaluated according to the fourth and fift h editions of the TNM classification agreed upon by the International Union Against Cancer and the American Joint Committee on Cancer. The p articular aim of this study was to lest the prognostic relevance of th e subdivision of Stage IV, especially for mucosal carcinoma. RESULTS. In classifying the primary tumor, the most extensive changes were note d for supraglottic and salivary gland tumors. On the basis of the four th edition of the TNM classification, the following recurrence free 5- year survival rates for 3033 cases of mucosal cancer were calculated: Stage I, 91.0%; Stage II, 78.6%; Stage III, 61.4%; Stage IV, 31.0%. Th e calculations based on the fifth edition yielded the following: Stage I, 91.0%; Stage II, 77.2%; Stage III, 61.2%; Stage IVA, 32.4%; Stage IVB, 25.3%; Stage IVC, 3.6%. CONCLUSIONS, The adequacy of the revised stage classification in establishing a prognostic hierarchy was confir med. However, a significant prognostic distinction between N2 metastas is (Stage IVA) and N3 metastasis (Stage IVB) could not be found. Cance r 1998;83:2201-7. (C) 1998 American Cancer Society.