Carlo Calearo

A comparison between TNM and TANIS stage grouping for predicting prognosis of oral and oropharyngeal cancer

PURPOSE The 1987 TNM classification system modified some T and N definition but it did not change stage grouping. Consequently it has not improved the prognostic validity of the advanced stage groups. In 1993, a new stage grouping was purposed, TANIS, that seems to have a higher correlation with survival. In this report, the TNM classification and TANIS system were compared to evaluate this prognostic ability. PATIENTS AND METHODS Data from 164 patients affected by primary cancers of oropharynx or oral cavity were analyzed by means of Kaplan-Meier and Cox regression analysis. RESULTS The crude survival rate at 5 years was 43.9%. Both systems showed a significant correlation with the survival rate by means of Cox regression analysis. TANIS subcategories were correlated to the mortality rate in the stage IV patients. TANIS resulted a better predictor of mortality when compared with TNM. CONCLUSION The TANIS system was able to separate the TNM stage IV patients into prognostic groups, yielding more information with respect to TNM for such a category of patients. When a comparison between TNM and TANIS was performed, it was observed that TANIS had a higher correlation with survival rate, whereas TNM did not add any information in defining the survival function.

Cancer of the nasal cavity and paranasal sinuses: A new staging system

This study proposes a new staging system for cancer of the paranasal sinuses on the basis of two concepts. The first concept is that the nasal cavity and the paranasal sinuses form a single unit. Consequently, the mucosa of each sinus may give rise to tumors. The histopathologic variation will be the same for all these cavities. The second concept is that the staging of these tumors depends both on the nature of the neoplastic cells and on the specific bone boundaries which surround the anatomic site and subsites. We analyzed 61 cases and we emphasize the need for a differential analysis of T4 tumors depending on which adjacent region is involved.

Unresectable primary tumor of head and neck: does neck dissection combined with chemoradiotherapy improve survival?

A study regarding patients with primary and previously untreated advanced histologically proven squamous cell carcinoma of the head and neck was performed to compare two treatment modalities: neck dissection followed by chemoradiotherapy (Group I) versus chemoradiotherapy alone (Group II). Fifty-four patients were randomly chosen to receive Group I or II treatment. Our results demonstrate that Group I treatment has a higher and statistically significant disease-specific survival rate. We suggest that an association of neck dissection plus chemoradiotherapy can be useful in the event of unresectable advanced carcinomas.

Site-dependent survival in cancer of the oral cavity.

&NA; A series of 100 patients affected by primary squamous cell carcinoma of the oral cavity treated at the Ear, Nose, and Throat Clinic of Ferrara from January 1980 to December 1989 was considered in this retrospective study. Data set was classified according to Union Internationale Contre le Cancer staging system. Results showed a crude survival rate at 5 years of 54%. Tumor site of origin and N, adjusted for sex and age of patients were the most important prognostic variables for survival rate. T stage and therapy did not achieve a significant value in the correlation with survival rate when used as covariates in multivariate analysis. The present study demonstrates that survival decreases the closer the tumor origin is to the inner sites of the mouth and in relation to N status. In cases with these characteristics, multimodality treatment protocols are useful in improving survival.

Parotid gland carcinoma: 1987 and 1997 UICC T classifications compared for prognostic accuracy at 5 years

Abstract In order to compare the correlation of 1987 and 1997 UICC T categories with the survival rate in parotid gland carcinoma, 134 patients attending the ENT clinics at the University of Ferrara (from 1970 and 1993) and Firenze (from 1970 to 1990) were analyzed by means of survival analyses (Kaplan-Meier and Cox algorithms). This study demonstrated that both systems showed a significant correlation with the survival rate, but T 1997 resulted in a more reliable prognostic value by means of a higher odds ratio. We conclude that the newer (1997) UICC T category better defines the prognosis for cancer of the parotid gland and should have a higher impact on the clinical evaluation of patients.

Primary malignancies of the nasal fossa and paranasal sinuses: comparison between UICC classification and a new staging system.

&NA; There is not a general accepted classification for tumor of nasal cavity and paranasal sinuses, and furthermore, there is a lack in the most commonly used T staging, the Union Internationale Contre Cancer (UICC) and the American Joint Committee on Cancer systems, which offer a classification strictly for tumors of the maxillary antrum. A new T staging (NTS) has been proposed: It is applicable to neoplasms arising from the mucosa of nasal fossa and all paranasal sinuses. To evaluate the advantages of NTS, a retrospective analysis of 54 cases of paranasal sinus cancers in patients admitted between 1983 and 1993 was undertaken. Tumors were staged according to UICC and to NTS systems, and then a statistical comparison was performed. Univariate analysis stratified according with T stage, tumors origin, and treatment modalities demonstrated different survival rates in both systems. Multivariate analysis showed a higher risk of death into the T4 category coded according with NTS with respect to UICC system. We concluded that NTS offers some advantages: (1) It presents a general view of the maxillofacial cavities; (2) it prognosticates successfully for T stage (1‐4); (3) it gives significant improvement in detecting the risk of death for T4 when compared with the UICC system.

Stage grouping of oropharyngeal cancer: evaluation of three systems by means of survival analysis.

Stage grouping is a method of summarizing multiple categories generated from the tumor, node, metastasis (TNM) classification system. Recently three different systems, the T and N integer score (TANIS), Hart, and 1997 Union Internationale Contre le Cancer systems, have been proposed. To verify their correlation to survival, a series of 64 patients affected by primary squamous cell carcinoma of the oropharynx was considered in this retrospective study. The data set was classified according to Union Internationale Contre le Cancer T stage and then grouped as recommended by the three systems. Results showed a crude survival rate of 28.13%. Univariate analysis by means of the logrank test yielded significant P values for the T and N integer score and Hart systems (0.0452 and 0.0179, respectively) and a borderline P value (0.0728) for the stratification based on the 1997 Union Internationale Contre le Cancer system. Multivariate analysis (Cox regression adjusted for age and sex) showed a significant correlation between the three staging systems and the mortality rate. Odds ratios were 1.36 (95% confidence interval, 1.12-1.66), 1.58 (95% confidence interval, 1.18-2.12), and 1.63 (95% confidence interval, 1.08-2.48) for the T and N integer score, Hart, and 1997 Union Internationale Contre le Cancer systems, respectively. The T and N integer score system showed the best statistical correlation, but a conclusive result could not be achieved because of the low number of patients in this study.

Extension as a prognostic factor in oropharyngeal cancer: largest mucosal dimension compared with number of (sub)sites involved

We report a retrospective study of 64 patients with primary squamous cell carcinoma of the oropharynx. The tumours were classified by the UICC (Union Internationale Contre le Cancer) system and a New Tumour Staging (NTS) system. Results showed a crude survival of 29% at 5 years. The most important prognostic factor for survival rate was the tumour (T) stage in both classifications. NTS recommendations that consider the number of sites and subsites involved yield a better correlation between survival and T stage. NTS also discriminates better between the T stages than the UICC criteria.

Parotid Gland Carcinoma : Surgical Strategy Based on Local Risk Factors

To evaluate the best surgical strategy in cases of parotid gland carcinoma, local risk factors (T, N, histology, and treatment) were analyzed in a series of 134 patients. The efficacy of the facial nerve sacrifice in case of macroscopic tumor infiltration was tested by means of survival analyses (Kaplan-Meier and Cox algorithms). This study demonstrated that nerve preservation resulted in a better prognostic value when compared with resection only in the group of patients having a T1 or T2. In patients affected by T3 and T4, the different treatment did not show any difference in survival rate. In conclusion, the sacrifice of the facial nerve is not always able to improve the survival rate.

Supraglottic surgery in vestibular cancer

ZusammenfassungDie Arbeit synthetisiert die Erfahrungen der HNO-Klinik der Universität Ferrara mit der horizontalen supraglottischen Teilresektion des Kehlkopfes bei Kehlkopfeingangskrebsen.Die anatomischen Grundlagen dieser funktionellen Chirurgie, sowie die wichtigsten Prinzipien des Verfahrens werden beschrieben.Die Ergebnisse betreffen 121 Fälle (13 Fälle T1, 93 Fälle T2 und 15 Fälle T4) die in drei Gruppen geteilt wurden:1.Patienten, die nur mit Chirurgie behandelt wurden (68 Fälle);2.Patienten, bei denen aus verschiedenen Rücksichten auch eine Strahlentherapie durchgeführt wurde (39 Fälle);3.Patienten mit extralaryngealer Ausdehnung, die präoperativ bestrahlt wurden (14 Fälle). Der große Prozentsatz der Überlebensrate ist besonders bedeutungsvoll. Die Verfasser sind deshalb der Meinung, daß diese Resultate die Gültigkeit der supraglottischen Laryngektomie bestätigen, wenn die Indikationen streng respektiert werden.SummaryThis paper deals with the experience acquired in the E.N.T. Clinic of the University of Ferrara regarding horizontal supraglottic laryngectomy in vestibular cancer.The anatomical background of this functional surgery and the most important principles of the technique are specified.The results regard 121 cases (13 T1 cases, 93 T2 cases and 15 T4 cases) divided into three groups:1.patients who had only surgery (68 cases);2.patients who for various reasons also had complementary postoperative radiotherapy (39 cases);3.patients with extralaryngeal expansion who had preoperative radiotherapy (14 cases). The high overall survival rate for the 121 cases is particularly significant, as is the shortening of the high-risk period to less than the usual 5 years. The 4-year cure rate is 78% and remains unchanged right through the 7-year follow-up.The authors feel that these data demonstrate further the validity of supraglottic laryngectomy when its precise indications are rigorously observed.