title: Cancer of the oral cavity: a comparison between institutions in a developing and a developed nation.
abstract: BACKGROUND
  The literature suggests that the natural history of squamous cell carcinoma of the oral cavity may vary and the prognosis is different in patients from developing and developed nations. The objective of this study was to compare the clinical presentation, management, and outcome of patients with oral cancer treated at tertiary care cancer institutions in a developing nation (Brazil- Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo [HCACC]) with those from a developed nation (United States- Memorial Sloan-Kettering Cancer Center [MSKCC]).
  
  
  METHODS
  Between January 1990 and December 1994, 602 patients underwent initial treatment in the study institutions.
  
  
  RESULTS
  Overall, patients from HCACC had a higher predominance of men (78.8% vs 54.6%; p <.001) and a higher prevalence of tobacco (88.1% vs 77.8%; p =.002) and alcohol consumption (80.9% vs 69.8%; p =.004). More patients at HCACC had advanced disease (stage III/IV; 73.4% vs 37.4%; p<.001). Even though the overall outcome was poorer in patients from HCACC (p <.001), after controlling for stage, there was not a statistically significant difference in disease-free or overall survival between the two institutions. Only at cancer-specific survival for early-stage disease (stage I/II) patients showed a difference (p =.05). Moreover, clinical stage (RR, 3.7; 95% CI, 2.6-5.5) and definitive treatment (RR, 3.3; 95% CI, 2.4-4.6) were the only factors that remained as significant predictors of outcome on multivariate analysis. Finally, the rate of subsequent second primary cancers was higher in patients from HCACC (p =.03).
  
  
  CONCLUSIONS
  Statistically significant differences were found in clinical presentation, tumor characteristics, and outcome in OC patients between the two institutions from a developing and developed nation. Overall outcome was poorer in HACC patients. However, after controlling for site, stage, and treatment, the outcome of these patients was similar, with the exception of a higher rate of occurrence of second primary cancers in patients from HACC. Given that the use of standard protocols of treatment offer similar outcomes, the establishment of education programs and screening measures for early diagnosis might be the best chance to improve overall outcome in OC patients in developing nations.
authors.affiliation: Head and Neck and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa, Hospital do Cancer, A. C. Camargo, Rua Antonio Prudente 211, Sao Paulo, Brazil 01509-900. cyan@uol.com.br
authors.forename: André L
authors.initials: AL
authors.lastname: Carvalho
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Spiro
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D019049:Developed Countries; D003906:Developing Countries; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology