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. 2013 Jan 1;119(1):81-9.
doi: 10.1002/cncr.27727. Epub 2012 Jun 26.

An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center: a staging system in need of repair

Kristina R Dahlstrom  1 , Gabriel Calzada, Jennifer D Hanby, Adam S Garden, Bonnie S Glisson, Guojun Li, Dianna B Roberts, Randal S Weber, Erich M Sturgis
Affiliations

An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center: a staging system in need of repair

Kristina R Dahlstrom et al. Cancer. .

Abstract

Background: In this retrospective review, the authors examined demographic/clinical characteristics and overall survival in patients with squamous cell carcinoma of the oropharynx at a tertiary cancer center, and they report the characteristics that influenced any observed survival trends over time.

Methods: The study included 3891 newly diagnosed, previously untreated patients who presented at the authors' institution between 1955 and 2004.

Results: Over time, patients presented at younger ages and were more likely to have base of tongue or tonsil tumors and to be never-smokers or former smokers. Patients who were diagnosed between 1995 and 2004 were almost half as likely to die as those who were diagnosed before 1995 (hazard ratio, 0.6; 95% confidence interval, 0.6-0.8). In both multivariable and recursive partitioning survival analyses, the TNM staging system predicted the survival of patients who received treatment before 1995 but did not predict the survival patients treated during the period from 1995 to 2004.

Conclusions: Survival among patients with squamous cell carcinoma of the oropharynx improved substantially over the past 50 years. The main contributing factors were changes in clinical characteristics, in particular surrogates for positive human papillomavirus status. The current TNM staging system for squamous cell carcinoma of the oropharynx is inadequate. The incorporation of human papillomavirus status and perhaps smoking status into the TNM system is encouraged.

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Figures

Figure 1
Figure 1. Survival of SCCOP patients, by decade diagnosed
Ten-year overall survival of newly diagnosed patients with SCCOP treated at MD Anderson during 1955–2004, by decade diagnosed. Survival improved significantly in the most recent decade studied compared with 1955–1994 (p<.001). Median survival was 25.5 months for the 1955–1964 cohort, 26.5 months for the 1965–1974 cohort, 32.8 months for the 1975–1984 cohort, 44.8 months for the 1985–1994 cohort, and 73.3 months for the 1995–2004 cohort.
Figure 2
Figure 2
(a) Survival of SCCOP patients by stage, 1955–1994 (b) Survival of SCCOP patients by stage, 1995–2004. Panel A shows the ten-year overall survival by stage of newly diagnosed SCCOP patients treated at MD Anderson during 1955–1994 (stage I/II vs. IV, p<0.001). Panel B shows the ten-year overall survival by stage of newly diagnosed SCCOP patients treated at MD Anderson during 1995–2004 (stage III vs. I/II, p<.001 and stage IV vs. I/II, p=.115).
Figure 2
Figure 2
(a) Survival of SCCOP patients by stage, 1955–1994 (b) Survival of SCCOP patients by stage, 1995–2004. Panel A shows the ten-year overall survival by stage of newly diagnosed SCCOP patients treated at MD Anderson during 1955–1994 (stage I/II vs. IV, p<0.001). Panel B shows the ten-year overall survival by stage of newly diagnosed SCCOP patients treated at MD Anderson during 1995–2004 (stage III vs. I/II, p<.001 and stage IV vs. I/II, p=.115).
Figure 3
Figure 3. Classification of patients with SCCOP into risk-of-death categories and corresponding Kaplan-Meier survival curves. BOT/T, base of tongue or tonsil; OP, oropharyngeal site
(a) Classification of patients, 1955–1994. (b) Classification of patients, 1995–2004. (c) Overall survival for risk groups, 1955–1994. (d) Overall survival for risk groups, 1995–2004. Figure 3 shows the classification of patients with SCCOP into risk-of-death categories based on recursive partitioning analysis and corresponding Kaplan-Meier survival curves. Panel A shows the classification of patients diagnosed during 1955–1994, where group 1 corresponds to the lowest risk of death and group 4 corresponds to the highest risk of death. Each node lists the variable with the number of patients and median survival time for each. Panel B shows the classification of patients diagnosed during 1995–2004. Panel C shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1955–1994. Panel D shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1995–2004.
Figure 3
Figure 3. Classification of patients with SCCOP into risk-of-death categories and corresponding Kaplan-Meier survival curves. BOT/T, base of tongue or tonsil; OP, oropharyngeal site
(a) Classification of patients, 1955–1994. (b) Classification of patients, 1995–2004. (c) Overall survival for risk groups, 1955–1994. (d) Overall survival for risk groups, 1995–2004. Figure 3 shows the classification of patients with SCCOP into risk-of-death categories based on recursive partitioning analysis and corresponding Kaplan-Meier survival curves. Panel A shows the classification of patients diagnosed during 1955–1994, where group 1 corresponds to the lowest risk of death and group 4 corresponds to the highest risk of death. Each node lists the variable with the number of patients and median survival time for each. Panel B shows the classification of patients diagnosed during 1995–2004. Panel C shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1955–1994. Panel D shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1995–2004.
Figure 3
Figure 3. Classification of patients with SCCOP into risk-of-death categories and corresponding Kaplan-Meier survival curves. BOT/T, base of tongue or tonsil; OP, oropharyngeal site
(a) Classification of patients, 1955–1994. (b) Classification of patients, 1995–2004. (c) Overall survival for risk groups, 1955–1994. (d) Overall survival for risk groups, 1995–2004. Figure 3 shows the classification of patients with SCCOP into risk-of-death categories based on recursive partitioning analysis and corresponding Kaplan-Meier survival curves. Panel A shows the classification of patients diagnosed during 1955–1994, where group 1 corresponds to the lowest risk of death and group 4 corresponds to the highest risk of death. Each node lists the variable with the number of patients and median survival time for each. Panel B shows the classification of patients diagnosed during 1995–2004. Panel C shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1955–1994. Panel D shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1995–2004.
Figure 3
Figure 3. Classification of patients with SCCOP into risk-of-death categories and corresponding Kaplan-Meier survival curves. BOT/T, base of tongue or tonsil; OP, oropharyngeal site
(a) Classification of patients, 1955–1994. (b) Classification of patients, 1995–2004. (c) Overall survival for risk groups, 1955–1994. (d) Overall survival for risk groups, 1995–2004. Figure 3 shows the classification of patients with SCCOP into risk-of-death categories based on recursive partitioning analysis and corresponding Kaplan-Meier survival curves. Panel A shows the classification of patients diagnosed during 1955–1994, where group 1 corresponds to the lowest risk of death and group 4 corresponds to the highest risk of death. Each node lists the variable with the number of patients and median survival time for each. Panel B shows the classification of patients diagnosed during 1995–2004. Panel C shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1955–1994. Panel D shows the Kaplan-Meier survival curve by risk group for overall survival of OSCC patients diagnosed during 1995–2004.
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References

    1. Shiboski CH, Schmidt BL, Jordan RC. Tongue and tonsil carcinoma: Increasing trends in the U.S. population ages 20–44 years. Cancer. 2005;103(9):1843–1849. - PubMed
    1. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26(4):612–619. - PubMed
    1. Frisch M, Hjalgrim H, Jaeger AB, Biggar RJ. Changing patterns of tonsillar squamous cell carcinoma in the United States. Cancer Causes Control. 2000;11(6):489–495. - PubMed
    1. Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: An emerging epidemic of human papillomavirus-associated cancers? Cancer. 2007;110(7):1429–1435. - PubMed
    1. Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: A site-specific analysis of the SEER database. Int J Cancer. 2005;114(5):806–816. - PubMed

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