Analysis of prognostic factors in patients with oropharyngeal squamous cell carcinoma treated with radiotherapy alone or in combination with systemic chemotherapy.

OBJECTIVE

To assess the prognostic significance of several factors in oropharyngeal squamous cell carcinoma treated with radiotherapy alone or in combination with chemotherapy.

DESIGN

Retrospective study.

SETTING

Erasto Gaertner Hospital, Curitiba, Brazil, and A. C. Camargo Hospital, São Paulo, Brazil.

PATIENTS: A total of 361 patients treated for squamous cell carcinoma from January 1, 1990, to December 31, 2001.

INTERVENTIONS: Radiotherapy alone or with chemotherapy.

MAIN OUTCOME MEASURES: Disease-free survival, overall survival, and treatment response.

RESULTS

Most tumors were located at the tonsil (46.8%) or base of the tongue (28.0%) and were at clinical stage III or IV (92.8%). Treatment response was associated with Zubrod scale score, weight loss, number of comorbidities, symptom-severity and Piccirillo stages, hemoglobin level, tumor site, macroscopic appearance of the tumor, and clinical stage. The 5-year overall survival rate was 17.6% and disease-free survival rate was 16.2%. The significant prognostic variables were age; Zubrod scale score; weight loss; comorbidities; Berg, Piccirillo, and symptom-severity staging; involvement of adjacent soft-tissue areas and bone; lymph node mobility; clinical stage; and radiotherapy doses. The multivariate analysis showed Zubrod scale score, symptom-severity staging system, Berg staging system, comorbidities, and radiotherapy dose as independent prognostic factors.

CONCLUSION

A combination of clinical factors, such as symptoms, patients' general status, weight loss, and comorbidities, leads to a relevant stage of clinical severity that can be associated with the TNM stage as predictors of survival in oropharyngeal carcinoma.