New Clinical Severity Staging System for Cancer of the Larynx

Although statistics for cancer of the larynx are reported according to the tumor, node, metastasis (TNM) morphological staging system, functional clinical distinctions can identify major prognostic differences within the same morphological stage. This study was done to improve the staging system by incorporating pertinent clinical variables. In 193 patients with cancer of the larynx first treated between 1973 and 1985, the total 5-year survival was 66% (127/193). By TNM stage it was I, 78% (60/77); II, 67% (32/48); III, 60% (27/45); and IV, 35% (8/23). In three new functional severity stages that combined symptom severity and comorbidity, the corresponding rates were alpha, 83% (89/107); beta, 58% (34/59); and gamma, 15% (4/27). The functional severity stages could be combined with TNM stages to create a powerful new clinical severity staging system, in which the survival results were A, 88% (53/60); B, 80% (24/30); C, 63% (38/60); and D, 28% (12/43). These results demonstrate that inclusion of clinical variables in a formal staging system can strikingly improve prognostic estimations and classification of patients.

[1]  M. Baum,et al.  Time to abandon TNM staging of breast cancer? , 1992, The Lancet.

[2]  B. J. Bailey.  Beyond the 'new' TNM classification. , 1991, Archives of otolaryngology--head & neck surgery.

[3]  A R Feinstein,et al.  A Clinical‐Severity Staging System for Patients with Lung Cancer , 1990, Medicine.

[4]  W. Taylor,et al.  New staging system for nasopharyngeal carcinoma. Long-term outcome. , 1989, Archives of otolaryngology--head & neck surgery.

[5]  Donald E. Henson,et al.  Manual for Staging of Cancer, 3rd edition , 1988 .

[6]  B. Linn,et al.  Effects of Age and Nutritional Status on Surgical Outcomes in Head and Neck Cancer , 1988, Annals of surgery.

[7]  J P Vandenbroucke,et al.  Should we abandon statistical modeling altogether? , 1987, American journal of epidemiology.

[8]  W. Taylor,et al.  Prognostic Determinants and a New View of Staging for Patients with Nasopharyngeal Carcinoma , 1985, The Annals of otology, rhinology, and laryngology.

[9]  J. Jacobs,et al.  Staging parameters for cancers of the head and neck: A multi‐factorial analysis , 1985, The Laryngoscope.

[10]  A R Feinstein,et al.  On classifying cancers while treating patients. , 1985, Archives of internal medicine.

[11]  A R Feinstein,et al.  The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. , 1985, The New England journal of medicine.

[12]  A. Feinstein,et al.  Clinical Epidemiology: The Architecture of Clinical Research. , 1987 .

[13]  C. Wells,et al.  Comorbid and clinical determinants of prognosis in endometrial cancer. , 1984, Archives of internal medicine.

[14]  Leo Breiman,et al.  Classification and Regression Trees , 1984 .

[15]  L. Polissar,et al.  Accuracy of basic cancer patient data: results from an extensive recoding survey. , 1984, Journal of the National Cancer Institute.

[16]  A. Feinstein,et al.  Pretherapeutic morbidity in the prognostic staging of acute leukemia. , 1979, Archives of internal medicine.

[17]  J. Kirchner,et al.  Clinical vs histopathologic staging in laryngeal cancer. , 1979, Archives of otolaryngology.

[18]  Feinstein Ar,et al.  Clinical biostatistics , 1977, Clinical pharmacology and therapeutics.

[19]  A R Feinstein,et al.  Cancer of the larynx: a new staging system and a re-appraisal of prognosis and treatment. , 1977, Journal of chronic diseases.

[20]  A R Feinstein,et al.  A reappraisal of staging and therapy for patients with cancer of the rectum. I. Development of two new systems of staging. , 1975, Archives of internal medicine.

[21]  A. Feinstein,et al.  A reappraisal of staging and therapy for patients with cancer of the rectum. II. Patterns of presentation and outcome of treatment. , 1975, Archives of internal medicine.

[22]  A. Feinstein,et al.  The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. , 1974, Journal of chronic diseases.

[23]  A. Feinstein,et al.  The auxometric dimension. A new method for using rate of growth in prognostic staging of breast cancer. , 1974, JAMA.

[24]  T. Gordon,et al.  Editorial: Hazards in the use of the logistic function with special reference to data from prospective cardiovascular studies. , 1974, Journal of chronic diseases.

[25]  A R Feinstein,et al.  XVII. Synchronous partition and bivariate evaluation in predictive stratification , 1972, Clinical pharmacology and therapeutics.

[26]  Alvan R. Feinstein,et al.  XIV. The purposes of prognostic stratification , 1972 .

[27]  Feinstein Ar.  Scientific defects in the staging of cancer. , 1971 .

[28]  A R Feinstein,et al.  THE PRE-THERAPEUTIC CLASSIFICATION OF CO-MORBIDITY IN CHRONIC DISEASE. , 1970, Journal of chronic diseases.

[29]  A. Feinstein.  Taxonorics. II. Formats and coding systems for data processing. , 1970, Archives of internal medicine.

[30]  MacKinnon Dm.  Validity of clinical data retrieved from case notes of laryngeal and hypopharyngeal cancer: a universal method to improve accuracy. , 1970 .

[31]  J. Kirchner.  LX One Hundred Laryngeal Cancers Studied by Serial Section , 1969 .

[32]  A R Feinstein,et al.  The Epidemiology of Cancer Therapy: IV. The Extraction of Data From Medical Records , 1969 .

[33]  A R Feinstein,et al.  The Epidemiology of Cancer Therapy: III. The Management of Imperfect Data , 1969 .

[34]  A. Feinstein,et al.  A new staging system for cancer, and a re-appraisal of "early" treatment and "cure" by radical surgery. , 1968, Transactions of the Association of American Physicians.

[35]  A. Feinstein.  Symptoms as an Index of Biological Behaviour and Prognosis in Human Cancer , 1966, Nature.

[36]  C. Norris,et al.  Part III—symptomatology and diagnosis: Cancer of the larynx , 1962 .

[37]  I. Macdonald.  The individual basis of biologic variability in cancer. , 1958, Surgery, gynecology & obstetrics.

[38]  F. Leborgne.  Classification of carcinoma of the larynx , 1953, The Laryngoscope.

[39]  D. Karnofsky,et al.  The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma , 1948 .

[40]  T. E. Walsh.  The classification of carcinoma of the larynx , 1947, The Laryngoscope.

[41]  W. Taylor,et al.  Prognostic variables in osteosarcoma: a multi-institutional study. , 1989, Journal of the National Cancer Institute.

[42]  A. Feinstein,et al.  A new clinical-anatomic staging system for evaluating prognosis and treatment of prostatic cancer. , 1986, Journal of chronic diseases.

[43]  D. Harrison.  Intrinsic weakness of the TNM system for classification of laryngeal cancer. , 1979, ORL; journal for oto-rhino-laryngology and its related specialties.

[44]  A. Ferlito.  Histological classification of larynx and hypopharynx cancers and their clinical implications. Pathologic aspects of 2052 malignant neoplasms diagnosed at the ORL Department of Padua University from 1966 to 1976. , 1976, Acta oto-laryngologica. Supplementum.

[45]  V. Aw.  Classification, anatomy, growth, and spread of laryngeal cancer. , 1974 .

[46]  A. Feinstein.  Clinical biostatistics. XVI. The process of prognostic stratification. 2. , 1972, Clinical pharmacology and therapeutics.

[47]  A. Feinstein.  Clinical biostatistics. XV. The process of prognostic stratification. I. , 1972, Clinical pharmacology and therapeutics.

[48]  A. Feinstein.  Clinical biostatistics. XIV. The purposes of prognostic stratification. , 1972, Clinical pharmacology and therapeutics.

[49]  J. Kirchner.  One hundred laryngeal cancers studies by serial section. , 1969, The Annals of otology, rhinology, and laryngology.

[50]  A. Feinstein,et al.  The epidemiology of cancer therapy. I. Clinical problems of statistical surveys. , 1969 .

[51]  W. S. Maccomb.  Classification of cancer of the pharynx and the larynx. , 1960, Proceedings. National Cancer Conference.