An extended clinical severity staging system can be used to estimate prognosis in patients with oral carcinomas involving the tongue or floor of the mouth. The extended clinical staging system is based on the Functional Severity Index (FSI) and the clinical or TNM tumor stage. The extended clinical stage can help the clinician and patient decide on a level of therapy based on the probable prognosis. The authors are from the University of Sao Paulo in Brazil.
Components for Functional Severity Index (FSI):
(1) neck lump
(2) dysphagia
(3) earache
(4) oral cavity bleeding
(5) weight loss
(6) comorbidity by NCI classification
(7) age
(8) daily alcohol consumption
(9) hematocrit
|
Parameter |
Finding |
Points |
|
neck lump |
no |
1 |
|
|
yes |
2.1 |
|
dysphagia |
no |
1 |
|
|
yes |
2.1 |
|
earache |
no |
1 |
|
|
yes |
2.0 |
|
oral cavity bleeding |
no |
1.0 |
|
|
yes |
2.6 |
|
weight loss |
no |
1.0 |
|
|
yes |
1.7 |
|
comorbidity by NCI classification |
level 1 (0-3 conditions) |
1.0 |
|
|
level 2 (>= 4 conditions) |
1.6 |
|
age |
<= 50 |
1.0 |
|
|
> 50 |
1.8 |
|
daily alcohol consumption |
no |
1.0 |
|
|
yes |
2.3 |
|
hematocrit |
> 35% |
1.0 |
|
|
<= 35% |
2.1 |
functional severity index (FSI) =
= PRODUCT(points for all 9 parameters)
Evaluation of FSI:
• minimal FSI: 1
• maximal FSI: 542.3
|
FSI |
Grade |
|
<= 3.8 |
low |
|
> 3.8 and < 8.7 |
intermediate |
|
>= 8.7 |
high |
|
TNM or Clinical Stage |
Functional Severity Index |
Extending Clinical Severity Stage |
|
I |
low |
1 |
|
I |
intermediate |
1 |
|
I |
high |
2 |
|
II |
low |
1 |
|
II |
intermediate |
1 |
|
II |
high |
4 |
|
III |
low |
2 |
|
III |
intermediate |
3 |
|
III |
high |
4 |
|
IV |
low |
2 |
|
IV |
intermediate |
4 |
|
IV |
high |
4 |
|
Extended Clinical Severity Stage |
5 Year Overall Survival |
|
1 |
74% |
|
2 |
47.1% |
|
3 |
28.6% |
|
4 |
8.4% |
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
