title: Prognostic staging system for recurrent, persistent, and second primary cancers of the oral cavity and oropharynx.
abstract: OBJECTIVE
  To develop a practical staging system for predicting mortality of patients with recurrent squamous cell tumors of the oral cavity and oropharyngeal mucosa.
  
  
  METHODS
  An inception cohort at an academic medical center.
  
  
  METHODS
  A total of 308 patients who had evidence of recurrent, persistent, or second primary tumors of the oral cavity and oropharynx between January 1, 1980, and December 31, 1991, of whom 162 (52.6%) met inclusion criteria.
  
  
  METHODS
  One-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, local and systemic symptoms, and eating function had significant effects on mortality. Multivariable analysis (done by conjunctive consolidation 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 demarcated 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 predicts mortality, but constrictor muscle invasion and weight loss also have major prognostic importance. The consolidation of these variables into a composite staging system successfully stratifies patients with widely divergent mortality rates. Improved staging of recurrent head and neck tumors can lead to more effective decisions about the comparisons and merits of additional treatment.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, University of Washington School of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle 98108, USA. byueh@u.washington.edu
authors.forename: B
authors.initials: B
authors.lastname: Yueh
authors.forename: A R
authors.initials: AR
authors.lastname: Feinstein
authors.forename: E M
authors.initials: EM
authors.lastname: Weaver
authors.forename: C T
authors.initials: CT
authors.lastname: Sasaki
authors.forename: J
authors.initials: J
authors.lastname: Concato
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000473:pathology*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology*; D009960:Oropharynx / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate