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 number of changes concerning head and neck tumors. The division of Stage IV tumors into three subcategories marks a significant expansion of the stage grouping procedure.


METHODS
In a retrospective study, the clinical courses of 3247 patients with carcinoma of the oral cavity, the oro- and hypopharynx, the larynx, the salivary glands, and the maxillary sinus were comparatively evaluated according to the fourth and fifth editions of the TNM classification agreed upon by the International Union Against Cancer and the American Joint Committee on Cancer. The particular aim of this study was to test the prognostic relevance of the subdivision of Stage IV, especially for mucosal carcinoma.


RESULTS
In classifying the primary tumor, the most extensive changes were noted for supraglottic and salivary gland tumors. On the basis of the fourth 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%. The 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 confirmed. However, a significant prognostic distinction between N2 metastasis (Stage IVA) and N3 metastasis (Stage IVB) could not be found.
Iro
H
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Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University, Homburg, Germany.
Waldfahrer
F
F
D002277:Carcinoma / Q000145:classification / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005260:Female; D005931:Glottis; D017408:Guidelines as Topic; D006258:Head and Neck Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000145:classification / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000145:classification / Q000473:pathology; D012955:Societies, Medical / Q000592:standards