Mitochondrial DNA in idiopathic cardiomyopathy

143 women treated in 28 departments from 1980 to 1995 were retrospectively analysed to study the impact of prognostic factors in primary carcinoma of the fallopian tube. The mean age of the patients was 62.5 years. Sixty (42%) tumours were FIGO stage I, 28 (20%) stage II, 38 (27%) stage III, 17 (12%) stage IV. Complete radical resection was achieved in 102 (71%) patients. In 122 (85%) women, surgery involved removal of the uterus, the adnexa, and/or the omentum or lymph nodes. Postoperative therapy consisted of either irradiation (n = 40; 28%) or chemotherapy (n = 70; 49%); 33 women (23%) did not receive any treatment after surgery. The 5-year survival rate for all cases was 43%. The 5-year survival rate was 59% for stages I and II and 19% for stages III and IV (P < 0.00001). FIGO stage, histological grade and presence of residual tumour had an independent prognostic impact in multivariate analysis. In order to investigate the role of p53 in primary fallopian tube carcinomas, we analysed the immunohistochemical expression of p53 protein regarding survival and FIGO stage in 63 patients (44%). No statistical significance was observed.     

A phase II trial and pharmacokinetic analysis of 96-hour infusional paclitaxel in patients with metastatic colorectal cancer

AIMS: To carry out a retrospective study of male breast cancer over a 22-year experience. METHODS: Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. RESULTS: In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P<0.001). In these patients, univariate analysis demonstrated that axillary status (relative risk of death in positive status vs. negative=3.6), tumour size (relative risk in T3 vs. T1-2=2), surgical treatment type (relative risk in simple mastectomy vs. radical mastectomy=1.9) and adjuvant chemotherapy (relative risk if no chemotherapy=1.4) were statistically significant factors associated with survival. CONCLUSIONS: Cox's regression model revealed that axillary status, tumour size and type of surgical treatment were the most important independent prognostic factors (P<0.001).     

Clinical presentation and prognostic factors in sodium monofluoroacetate intoxication

From 1970 to 1992 a total of 63 patients underwent operation for ampullary tumor: 40 pancreatoduodenectomies (PDs), 3 total PDs, 8 ampullectomies, and 12 bypass or exploratory laparotomies. The resectability rate was 68%. There were 9 benign tumors, 1 anaplastic tumor, and 53 adenocarcinomas. According to Martin's classification, there were 7 stage I, 11 stage II, 14 stage III, and 21 stage IV tumors. All patients with stage I, II, and III tumors underwent resection. Patients with stage IV tumors had either resection (n = 11) or bypass (n = 10). The mean duration of hospital stay was 20.6 days. Operative mortality was 12.7% for the whole series and 7.5% after PD (2.5% for the last 10 years). Overall survival was 40% at 5 years (85% for stage I, 65% for stage II, 44% for stage III, and 8% for stage IV). Survival was better for stages I, II, and III after PD than after ampullectomy. For stage IV patients survival was 70% after PD versus 20% after bypass at 1 year and 25% versus 0% after 2 years. In our opinion, PD should be proposed even for benign lesions because two of our patients had to undergo repeat operation (PD) 4 and 22 years later, respectively, for stage IV disease. PD is our choice for all tumors of the ampulla.     

Ultrastructural analysis of hepatitis B virus in HepG2-transfected cells with special emphasis on subviral filament morphogenesis

BACKGROUND: Conventional therapy for pleural mesothelioma has met with disappointing results. METHODS: From 1991 to 1996, 40 patients with malignant pleural mesothelioma were treated with surgical resection followed by immediate intracavitary photodynamic therapy. RESULTS: The series included 9 women and 31 men with a mean age of 60 years. Morbidity and treatment-related mortality rates for the entire series, pleurectomy, and extrapleural pneumonectomy were 45% and 7.5%, 39% and 3.6%, and 71% and 28.6%, respectively. Median survival and the estimated 2-year survival rate for the entire series, stages I and II patients (n = 13), and stages III and IV patients (n = 24) were 15 months and 23%, 36 months and 61%, and 10 months and 0%, respectively. Multivariate analysis identified stage, length of hospital stay, photodynamic therapy dose, and nodal status as independent prognostic indicators for survival. CONCLUSIONS: Surgical intervention and photodynamic therapy offer good survival results in patients with stage I or II pleural mesothelioma. For patients in stage III or IV, better treatment modalities need to be developed. Improvements in early detection and preoperative staging are necessary for proper patient selection for treatment.     

Intra-oral cancer at the Massachusetts General Hospital. Squamous cell carcinoma of the floor of the mouth

A retrospective review of 163 consecutive patients with biopsy-proven, invasive squamous cell carcinoma of the floor of the mouth who underwent inpatient treatment at the Massachusetts General Hospital during the 15-year period from January 1962 through December 1976 is presented. The stage at first presentation, clinical features of the disease, incidence of second primary tumors, analysis of therapeutic modalities, and survival statistics are compared with reports from other large centers. Floor of mouth tumors comprised 28%, (163/592) of oral squamous cell carcinomas seen at the Massachusetts General Hospital during that time period. Seventy-one per cent of floor of mouth tumors were in men and 29% in women; women tended to present earlier in the course of their disease. Thirty-seven patients (23%) developed a secondary primary malignancy, and four of these 37 patients developed two second primaries. Distant metastatic disease appeared in 6% of patients with Stage I, II, or III disease and 26% of patients with Stage IV disease. Radiation therapy alone and surgery alone resulted in equivalent long-term survival rates for early stage disease. In more advanced stages (III and IV), a combined approach utilizing surgery and radiation therapy obtained superior results for short-term survival than either modality alone. The importance of early diagnosis and treatment and suggestions for development of cooperative protocols in an attempt to improve salvage of patients with this disease is discussed.     

Carcinoma of the tonsil. Analysis of 162 cases

The treatment of 162 patients with squamous cell carcinoma of the tonsil seen at the University of Virginia Medical Center, Charlottesville, from 1955 through 1974 was reviewed. One hundred four patients form the basis of this report. The patients were grouped by the stage of disease, and then three- and five-year determinate survival, recurrences, distant metastases, and complications were examined. The treatment used was surgery, radiation, or a combination of preoperative radiation and surgery. The overall five-year determinate survival for stage I was 93.3%; stage II, 57%; stage III, 27%; and stage IV, 17%. The five-year determinate survivals of patients treated with surgery alone, radiation, and combination therapy were 88%, 27%, and 32%, respectively. The latter two treatment modalities were biased by a greater proportion of patients with stage III and IV disease, whereas surgery alone included a high proportion of patients with stage I and II disease. Based on this review and those reported in the literature, we recommend radical radiation therapy for stage I and II disease and combination radiation therapy and composite resection for stages III and IV.     

Surgical treatment of primary lung cancer in patients less than 40 years of age

PURPOSE AND METHODS: The major purpose of this study was to determine whether the survival rate in young lung cancer patients after surgical treatment differs from that in older patients. An analysis was performed for all patients with bronchogenic carcinoma who underwent surgery at Mie University Hospital from 1965 to 1990. RESULTS: Of 803 patients, 24 (2.99%) were 33 to 39 years old. At the time of surgery, the disease was diagnosed as stage I in seven patients (29%), stage II in four (17%), stage IIIa in seven (29%), stage IIIb in two (8%), and stage IV in four (17%), while 46.3% of the patients older than 40 years of age had either stage IIIa, IIIb, or IV disease. All of the 24 patients less than 40 years of age underwent thoracotomy: curative resection in 14 cases, palliative resection in sex, and probe-thoracotomy in four. The 5-year survival rate for all stages of disease was 31.4% in these 24 patients, and 41.9% in 603 patients greater than 40 years of age. The 5-year survival rate for stage I disease was 35.7% in the seven younger patients and 78.0% in the 207 older patients; for stage II, it was 25.5% in the four younger patients and 40.6% in the 98 older patients; for stage III, it was 33.3% in the nine younger patients and 15.6% in the 250 older patients; and for stage IV, it was 25% in the four younger patients and 6.6% in the 48 older patients. There were no significant differences in survival rate between the two age groups for all patients or for those with each stage of disease. CONCLUSION: Although younger patients tended to have more advanced disease, long-term survival in these patients did not differ from that of older patients.     

Surgery for gastric remnant carcinoma following Billroth II gastrectomy

Between January 1983 and December 1995, 31 patients with gastric remnant carcinoma were operated on 6-45 years after a Billroth II resection for peptic ulcer disease. Total gastrectomy with Roux-en-Y reconstruction was performed in all cases. In 16 patients (52%) extended resection with removal of one or more adjacent organs was necessary for oncological reasons. In this elderly population with a high incidence of pre-operative risk factors (55%), most tumours were classified as stage III or IV (45%). Although total gastrectomy should be the surgical option of first choice for gastric remnant carcinoma, it resulted in high levels of post-operative mortality and morbidity (13% and 35%, respectively), especially in patients with stage III and IV tumours who underwent resection of an adjacent organ. Despite extended surgery, if necessary, the recurrence rate after 'curative' surgery is high (8/20 patients) and the cumulative disease-free 5-year survival rate was 48%. Detection of the tumour at an earlier stage not only limits the extent of resection and lowers the complication rate, but also improves survival.     

Surgical treatment of bronchogenic carcinoma. Long-term results in 496 surgical patients

BACKGROUND: The operability of lung cancer and the period of survival after resection of the lungs in our country does not yet attain the standard recorded in some advanced countries. The objective of the present work is to analyze factors which influence the survival period after resection therapy of lung cancer. METHODS AND RESULTS: In 1985-90 in our department 496 patients were operated on account of lung cancer. This number comprised 31 patients subjected to explorative thoracototomy and three patients with pulmonary resection on account of a stage IIIb (pTNM) tumour who were excluded from the statistical analysis. The retrospective study proper analyzes the results of 462 patients (403 men and 59 women) operated in stages I, II and IIIa. Their mean age was 57 years (range 30-74 years, SD 7.5 years). The most frequent histological type was epidermoid carcinoma (68.8%), adenocarcinoma 18.2%, small-cell tumours 5.4% (25 patients). In 262 patients operated on account of lung cancer in stage I (pTNM) the probability of five-year survival was 49.2%, in patients in stage II 42.1%, in 158 patients in stage IIIa 20.9% (for all histological types combined). In 437 patients after resection of the lungs on account of non-small-cellular carcinoma the probability of five-year survival was as follows: stage I 50.0%, stage II 45.0%, stage IIIa 21.2%. CONCLUSIONS: The probability of five-year survival for the whole group of 462 patients in stages I, II and IIIa was 38.8%. The most important factor which influenced the probability of five-year survival was the stage of the disease. Neither age nor sex of the patients nor the histological type of the tumour had a statistically significant effect on the probability of five-year survival.     

Survival in ovarian cancer treated in a gynecological department of a central hospital

The characteristics of 73 patients with all stages of epithelial ovarian cancer were retrospectively analysed with emphasis on prognostic factors and survival. The patients underwent total hysterectomy, bilateral oophorectomy and infracolic omentectomy. Efforts were made to reduce the tumor burden as much as possible without endangering the general health status of the patient. Postoperative treatment was cisplatin 60 mg/m2 body surface and cyclophosphamide 50 mg/m2 every four weeks (CP). Patients with low general health status were offered either treosulphane 1 g daily for four weeks alternating with four weeks without treatment, or no treatment. Patients in FIGO stage IA and B generally received no postoperative chemotherapy treatment. Fifteen percent were in FIGO stage I, 7% in stage II, 5% in stage III and 23% in stage IV. Fifteen patients could be radically operated, however, only three patients who were in stage III. Fifty-four patients were treated with CP, 11 with treosulphane and eight patients did not receive postoperative treatment. In 28 patients second look laparotomy was performed. Only six patients had a complete pathological response, two of these in stage III. Stage and tumour grade could be identified as prognostic factors. Three-year survival was 70% in stage I, 67% in stage II, 28% in stage III and 0% in stage IV. Survival in 43 patients in stage III and IV was statistically compared to 265 patients from a prospective, randomized study by the Danish Ovarian Cancer Group (DACOVA), comparing cyclophosamide and cisplatin with and without doxorubicin. We found no statistical difference in survival between patients in our material and the DACOVA-material except in patients with low grade tumours whose survival in the CAP-arm of the DACOVA-study was superior. The rate of complete pathological response was significantly better in the DACOVA-study.     

Steady-state pharmacokinetics and electrocardiographic pharmacodynamics of clarithromycin and loratadine after individual or concomitant administration

Telomerase activity was analyzed in 52 patients with resected esophageal squamous cell carcinoma by telomeric repeat amplification protocol (TRAP) assay. Telomerase activity was detected in 41 out of 52 (79%) carcinomas and detected in 46 out of 52 (89%) normal esophageal epitheliums adjacent to the carcinomas. In carcinoma, the telomerase activity was detected more frequently in relatively early stages of carcinoma (in 8 of 9 patients with stage 0, in 3 of 3 patients with stage I, and in 4 of 4 patients with stage II). However, the telomerase activity was detected in only 8 of 12 patients with stage III and in 16 of 21 patients with stage IV. Thus, the percentage of patients who had tumors without telomerase activity increased in more advanced stages. These results indicate that telomerase activity may correlate with carcinogenasis of esophageal cancer, however, it may not correlate with progression of esophageal squamous cell carcinoma.     

Prognostic value of nuclear grade of renal cell carcinoma

BACKGROUND: The authors assessed the interest and the value of Fuhrman's nuclear grade as a possible prognostic factor for renal cell carcinoma (RCC). METHODS: An 11-year retrospective study of 190 patients with RCC treated by radical nephrectomy was performed. The distribution by grade was: Grade I, 54 patients; Grade II, 58; Grade III, 58; and Grade IV, 20. The distribution of the patients by tumor stage according to the TNM15 classification was: pT1, 56 patients; pT2, 41; pT3a, 55; pT3b, 25; pT3c + pT3d + pT4b, 5; and pT4a, 8. Significant correlations with other prognostic parameters were noted. Survival curves by grade were evaluated by the Kaplan-Meier method. RESULTS: Nuclear grade was correlated with tumor stage (P = 0.0001), synchronous metastases (P = 0.003), lymph node involvement (P = 0.0001), renal vein involvement (P = 0.0001), tumor size (P = 0.0001), and perirenal fat involvement (P = 0.001). No correlation was found between nuclear grade and tumor multicentricity (P = 0.14) and cell type (P = 0.2). Nuclear grade was an effective parameter in predicting development of distant metastases after nephrectomy. Among the 54 patients who presented with Grade I tumors, only one tumor did metastasize during the 5-year follow-up, whereas 17% of the Grade III and 30% of the Grade IV tumors metastasized. The 5-year actuarial survival rates of the patients with Grade I, II, III, and IV tumors was 76%, 72%, 51%, and 35%, respectively. The comparison of the survival curves by grade showed a statistically significant difference between the curves when Grade I and II tumors were compared with Grade III and IV tumors (P = 0.001). CONCLUSION: In this study, nuclear grade was found to have prognostic significance and seems to be an important criterion when considering the outcome of patients with RCC.     

Surgical treatment in proximal bile duct cancer. A single-center experience

OBJECTIVES: The authors evaluated the experience and results of a single center in surgical treatment of proximal bile duct carcinoma. SUMMARY BACKGROUND DATA: Whenever feasible, surgery is the appropriate treatment in proximal bile duct carcinoma. To improve survival rates and with special regard to liver transplantation, the extent of surgical radicalness remains an open issue. PATIENTS AND METHODS: Retrospective analysis of 249 patients who underwent surgery for proximal bile duct carcinoma via the following procedures: resection (n = 125), liver transplantation (n = 25), and exploratory laparotomy (n = 99). Survival rates were calculated according to the Kaplan-Meier method, uni- and multivariate analysis of prognostic factors, and log rank test (p < 0.05). RESULTS: Survival rates after resection and liver transplantation are correlated with international Union Against Cancer (UICC) tumor stage (resection: overall 5-year, 27.1%; stage I and II, 41.9%; stage IV, 20.7%; liver transplantation: overall 5-year, 17.1%; stage I and II, 37.8%; stage IV, 5.8%). Significant univariate prognostic factors for survival after liver resection were lymph node involvement (N category), tumor stage, tumor-free margins, and vascular invasion; for transplantation, they were local tumor extent, N category, tumor stage, and infiltration of liver parenchyma. For resection and transplantation, a multivariate analysis showed prognostic significance of tumor stage and tumor-free margins. CONCLUSION: Resection remains the treatment of choice in proximal bile duct carcinoma. Whenever possible, decisions about resectability should be made during laparotomy. With regard to the observation of long-term survivors, liver transplantation still can be justified in selected patients with stage II carcinoma. It is unknown whether more radical procedures, such as liver transplantation combined with multivisceral resections, will lead to better outcome in advanced stages. With regard to palliation, surgical drainage of the biliary system performed as hepatojejunostomy can be recommended.     

Prognosis for patients with pneumonectomy or lesser resections for non-small cell lung cancer based on histologic cell type

Contrary results have been reported regarding prognosis by histologic cell type in surgical treatment for lung cancer. To evaluate whether histologic cell type has influence on prognosis, we separately analyzed the prognostic outcome of patients who had undergone pneumonectomy (n=119) and lesser resections (n=124) for non-small cell lung cancer (NSCLC) between January, 1985 and March, 1996. The pneumonectomy group included 87 (73%) squamous cell carcinoma (Sq), 25 (21%) adenocarcinoma (Ad) and 7 other types with 10 (8%) patients in postoperative stage I of the disease, 29 (24%) stage II, 74 (62%) stage III and 6 in stage IV. The lesser resection group included 45 (36%) Sq, 63 (51%) Ad and 16 other types with 71 (57%) patients in stage I, 9 (7%) stage II, 32 (26%) stage III and 12 stage IV. In patients with stages I-III, the 5-year survival rate was 42.8% for the Sq group and 41.1% for the Ad group in the case of lesser resections and 37.1% for the Sq group and 0% for the Ad group (p<0.05) in the case of pneumonectomy. The poorer prognosis for patients with Ad in the case of pneumonectomy was suspected to be due to the N factor; the percentage of patients with N0-1 was significantly lower in the Ad group than for the Sq group (28 vs 62%, p<0.005). Histologic cell type can be a prognostic factor for patients undergoing surgical treatments for NSCLC. One possible reason for the contrary results on prognosis by histologic cell type among investigators may be due to the mixed results of pneumonectomy and lesser resections.     

Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes

In this study we have determined the incidence of hepatocellular carcinoma (HCC) development in primary biliary cirrhosis (PBC) and its effects on patient survival. Six hundred and sixty seven patients with liver histology compatible with or diagnostic of PBC were seen over a 20-year period. Two hundred and seventy three patients who had stage III or IV disease on their last biopsy and who had been followed up for at least 1 year following that biopsy (total follow-up with advanced disease 2,010 patient years) were identified (243 female, 30 male). Patients who developed HCC were identified and their confounding risk factors were excluded. Mayo risk scores were calculated for each clinic attendance and expected survival for each time point was compared with subsequent actual survival. Sixteen cases of HCC were seen in the patients with stage III or IV disease on last biopsy, providing an overall incidence of 5.9% in this group. Fourteen of these patients had died of HCC related causes, and 2 patients were alive at the census point. The incidence of HCC was significantly higher in males with stage III/IV disease than in females (20% vs. 4.1%, P < .005). Nine of one hundred and eight (8.3%) total female deaths in this group was attributable to HCC compared with 5 of 11 (45.5%, P < .05) male deaths. HCC was not seen in any of the 394 patients with stage I and II PBC followed-up over the same time period. Throughout the disease course of all PBC patients with HCC, the Mayo prognostic model over-predicted survival. Whereas it is a relatively rare complication of cirrhotic PBC in women, HCC is a relatively common cause of death in male PBC patients with cirrhosis. HCC typically develops several years after the onset of cirrhosis, and is poorly predicted by prognostic models. In view of these findings, consideration should be given to careful screening for HCC in male PBC patients with cirrhosis. The risk of HCC development may be an additional reason to consider earlier transplantation in these patients.     

Penile cancer in Taiwan--20 years' experience at National Taiwan University Hospital

To analyze the characteristics and prognostic factors of penile cancer in Taiwanese, we retrospectively reviewed the clinical data of patients with a diagnosis of penile cancer treated during a 20-year period (1977-1996) at National Taiwan University Hospital (NTUH). Of 71 patients treated for penile cancer during the study period, 17 were referred from other hospitals or clinics. Our analyses focused on the 54 previously untreated patients. Growth on the penis was the main symptom in all cases. Palpable inguinal lymph nodes were found only in 14 patients. All 54 patients with primary tumors were treated surgically. Pathologic examination showed squamous cell carcinoma (SCC) in 43 cases, extra-mammary Paget's disease in three, verrucous carcinoma in three, Bowen's disease in two, cutaneous lymphoma in two and basal cell carcinoma in one. Twenty-six (48%) patients had stage I penile cancer, 13 (24%) had stage II, seven (13%) had stage III, and eight (15%) had stage IV cancer. The five-year survival rate was 78% among patients with SCC and 84% among those with nonsquamous malignancies (p = 0.80). The five-year cumulative survival rates according to Jackson's cancer stage were 100% for patients with stage I, 88.9% for those with stage II, 66.7% for those with stage III, and 0% for those with stage IV (p < 0.001). Tumor staging (p = 0.027) and adjuvant chemotherapy (p = 0.042) were found to be the most significant prognostic factors. Penile cancer accounted for 0.254% of all malignancies among male patients at the NTUH during the study period. Our findings indicate that penile cancer is uncommon in Taiwanese and its prognosis is closely related to tumor staging and management. Early diagnosis and appropriate treatment may lead to prolonged survival.     

Treatment of patients with malignant neoplasms of the nose and paranasal sinuses

The author analyzes and discusses characteristic features of the results of combined treatment in 260 patients with malignant tumours of the superior maxilla, nose and accessory sinuses. The majority of patients were from 40 to 60 years old (81.5%). These were 158 men and 102 women. Epithelial tumours were diagnosed in 91.5%, sarcomas in 8.5% cases. The flattened-cell form of cancer with or without keratosis was diagnosed in 82.7%; other forms of cancer-in 17.3% cases. Sarcoma in women was diagnosed 3.5 times as often as in men. Tumours of the I stage were found in 12, of the II stage in 34. of the III stage in 146, of the IV stage in 73 patients. All patients were subjected to combined treatment-telegammatherapy and resection of the tumour with an electroknife. Patients with cancer of the I stage were first operated on with the electroknife and then subjected to radiotherapy with a focal dose of 3000-4000 rad. The 34 patients with cancer of the II stage underwent preoperative radiotherapy with a focal dose of 4500 to 5000 rad, then surgical intervention followed in 2-5 weeks. Preoperative radiotherapy was practiced in the 146 patients with cancer of the III stage, the total dose per focus being 5000-6000 rad, surgical intervention followed in 3-5 weeks. The 73 patients with cancer of the IV stage were operated on after radiotherapy with a focal dose of 6500-700 rad. Early and remote results of combined treatment in 260 patients were favourable. The length of life was up to 3 years in 119 (45.77%), up to 5 years in 74 (28.46%), up to 10 years in 48 (18.5%), over 10 years in 22 (8.5%) patients.     

Recurrence and survival rate after surgical therapy of rectal carcinoma

Between 1983 and 1993, 680 patients with rectal carcinoma were treated at Ulm University. The resection rate was 84%. After undergoing radical surgery, 492 of the patients were followed up regularly at our hospital for a median of 66.9 months (range 4-177.6). Recurrences occurred in 172 patients (35%) and were diagnosed a median of 13 months (range 4-106 months) postoperatively; 9.4% had regional recurrences, 10.4% regional recurrences and distant metastases and 10.2% distant metastases. The 10-year survival rate of the patients in tumour stages I, II and III was 88%, 62%, and 32%. In patients with carcinoma of the midrectum, after anterior resection or abdominoperineal amputation the same local recurrence rate was found.     

Differential protein oxidation in Duchenne and Becker muscular dystrophy

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.     

Clinical staging of oropharyngeal carcinoma: a critical evaluation of a new stage grouping proposal

BACKGROUND: An alternative to the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) stage grouping system was proposed for patients with oropharyngeal carcinoma by Hart et al. (1995) on behalf of the Dutch Head and Neck Oncology Cooperative Group. The system was created by regrouping the T, N, and M categories without redefining the categories themselves. METHODS: Data related to epidemiology, treatment, and survival from 224 previously untreated patients with oropharyngeal carcinoma were analyzed. Staging was performed according to the 1992 UICC/AJCC criteria and according to the proposed stage grouping system. Kaplan-Meier estimates of overall survival were compared for both staging systems; and in a Cox proportional hazards regression analysis, the influence of the variables age, gender, subsite and side of tumor location, histopathologic grade, form of treatment, and stage distribution (according to 1992 UICC criteria and that proposed by Hart et al.) on overall survival was determined. RESULTS: The proposed staging system showed a more balanced distribution of patients (16% in Stage I, 37% in Stage II, 14% in Stage III, and 33% in Stage IV compared with 5% in Stage I, 7% in Stage II, 21% in Stage III, and 67% in Stage IV according to UICC/AJCC 1992 staging). Furthermore, the proposed staging system showed better prognostic discrimination for overall survival (5-year survival rates according to the staging system of Hart et al. were 59% in Stage I, 31% in Stage II, 28% in Stage III, and 16% in Stage IV, vs. 61% in Stage I, 59% in Stage II, 32% in Stage III, and 24% in Stage IV according to UICC/AJCC 1992 staging). CONCLUSIONS: The results are in concordance with the results published by the Dutch Head and Neck Oncology Cooperative Group. It is possible to improve the current staging system by regrouping the T, N, and M categories. [See editorial on pages 1611-2, this issue.]