A comparison of published head and neck stage groupings in carcinomas of the oral cavity.
BACKGROUND
The combination of T, N, and M classifications into stage groupings is meant to facilitate a number of activities, including the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. We tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer for their ability to meet these expectations in a specific site: carcinomas of the oral cavity.


METHODS
We defined four criteria to assess each grouping scheme: (1) the subgroups defined by T, N, and M that make up a given group within a grouping scheme have similar survival rates (hazard consistency); (2) the survival rates differ among the groups (hazard discrimination); (3) the prediction of cure is high (outcome prediction); and (4) the distribution of patients among the groups is balanced. We identified or derived a measure for each criterion, and the findings were summarized by use of a scoring system. The range of scores was from 0 (best) to 7 (worst). The data are population based from a prospectively gathered series in Southern Norway, with 556 patients diagnosed from 1983 through 1995. Clinical stage assignment was used, and the outcome of interest was cause-specific survival.


RESULTS
Summary scores across the eight schemes ranged from 1.66 for TANIS-3 to 6.50 for UICC/AJCC-5. The TANIS-7 staging scheme performed best on the hazard consistency criterion. The Kiricuta scheme performed best on the hazard discrimination criterion. Synderman predicted outcome best overall and Berg produced the most balanced distribution of cases among its groups.


CONCLUSIONS
UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically derived schemes we evaluated. Our results suggest that the usefulness of the TNM system could be enhanced by optimizing the design of stage groupings through empirical investigation.
Groome
P A
PA
Radiation Oncology Research Unit, Kingston General Hospital, Apps Level 4, Kingston, Ontario K7L 2V7, Canada.
Schulze
K
K
Boysen
M
M
Hall
S F
SF
Mackillop
W J
WJ
D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000145:classification* / Q000473:pathology*; D009367:Neoplasm Staging / Q000145:classification* / Q000379:methods; D015203:Reproducibility of Results; D016019:Survival Analysis