Impact of comorbidity, symptoms, and patients' characteristics on the prognosis of oral carcinomas.

OBJECTIVES To evaluate the impact of comorbidities, symptoms, and patients' characteristics on the 5-year overall survival of patients who underwent surgery for cancer of the oral tongue or floor of the mouth and to improve the survival estimates by the creation of a new staging system. PATIENTS AND METHODS A cohort of 110 patients with squamous cell carcinoma of the oral tongue or floor of the mouth, who were admitted to a tertiary cancer hospital from January 1, 1990, to December 31, 1994, and who underwent surgery was studied. Multivariate analysis distinguished that patients' characteristics, symptoms, and comorbidities have a significant impact on 5-year overall survival. This functional severity index combined with the TNM stage created the extended clinical severity staging system. RESULTS The 5-year overall survival was 33.4%. Survival by TNM cancer stage was 64.6% (stage I), 67.5% (stage II), 28.9% (stage III), and 13.1% (stage IV) (chi(2) = 22.88, P<.001). When patients were categorized according to the extended clinical severity staging system, survival was as follows: 74.0% (stage 1), 47.1% (stage 2), 28.6% (stage 3), and 8.4% (stage 4) (chi(2) = 38.67, P<.001). CONCLUSION Clinical variables have a prognostic impact on oral cancer that is surgically treated, and the consistency of results confirms that survival estimates can be improved by the addition of these elements to the TNM classification, creating a more powerful and precise system in the determination of a prognosis.