An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center

A staging system in need of repair

Authors

  • Kristina R. Dahlstrom MS,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Gabriel Calzada MD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Current affiliation:
    1. Kaiser Permanente Southern California, Downey, California
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  • Jennifer D. Hanby MD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Current affiliation:
    1. Acadian Ear, Nose, Throat, and Facial Plastic Surgery Center, Lafayette, Louisiana
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  • Adam S. Garden MD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Bonnie S. Glisson MD,

    1. Department of Thoracic Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Guojun Li MD, PhD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    2. Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Dianna B. Roberts PhD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Randal S. Weber MD,

    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Erich M. Sturgis MD, MPH

    Corresponding author
    1. Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    2. Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Head and Neck Surgery, Unit 1445, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030

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    • Fax: (713) 794-4662


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. Cancer 2013. © 2012 American Cancer Society.

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