Development of a new staging system for recurrent oral cavity and oropharyngeal squamous cell carcinoma

BACKGROUND. Approximately 33% of patients with squamous cell carcinoma of t he oral cavity and oropharynx develop a recurrence. The management of recur rent tumors can be challenging to both physician and patient, at least in p art due to the lack of an accurate and clinically applicable staging system for these patients. The purposes of this study were to examine the surviva l patterns of patients presenting with recurrent oral cavity and oropharyng eal tumors, to identify key factors affecting prognosis, and to combine the se factors to create a new staging system to predict survival and aid in pl anning therapy. METHODS. The methods included a retrospective chart review of 641 patients with oral cavity and oropharyngeal squamous cell carcinoma who underwent th eir initial treatment at Washington University between 1980 and 1992. From this population, 249 patients (39%) developed a recurrence. RESULTS. The overall 2-year survival rate was 20% (50 of 249 patients). Six variables affected survival significantly: histologic differentiation, ini tial (prior to first therapy) TNM stage, initial treatment, time to recurre nce, extent of recurrence, and treatment of recurrence. These six variables were entered into a logistic model to determine the individual prognostic significance of each variable. Two variables were found to be statistically significant: initial TNM stage (chi-square test = 7.67; P = 0.0056) and ex tent of recurrence (chi-square test = 11.75; P = 0.0006). Using the process of conjunctive consolidation, these two variables were combined to create a new staging system for recurrent tumors of the oral cavity and oropharynx . CONCLUSIONS. This staging system provides accurate estimates of prognosis, involves no new technology to implement, demonstrates statistically signifi cant differences in survival by stage, and may aid both the physician and t he patient in planning therapy. (C) 1999 American Cancer Society.