Peters et al identified certain risk factors associated with recurrence in patients with head and neck cancer treated at M.D. Anderson Cancer Center. This can identify patients at risk for local-regional recurrence who may benefit from more aggressive therapy.
Factors:
(1) primary site
(2) status of mucosal margins
(3) nerve invasion
(4) lymph node involvement
(5) size of largest lymph node
(6) treatment delay
(7) Zubrod (ECOG) performance scale (see Chapter 1)
Extracapsular nodal extension is a separate and independent risk factor for local-regional recurrence.
|
Factor |
Finding |
Points |
|
primary site |
mouth |
1 |
|
|
other |
0 |
|
mucosal margins |
close (< 5 mm) or positive |
1 |
|
|
negative |
0 |
|
nerve invasion |
present |
1 |
|
|
absent |
0 |
|
lymph nodes positive for metastatic disease |
>= 2 |
1 |
|
|
0 or 1 |
0 |
|
size of largest lymph node |
> 3 cm |
1 |
|
|
<= 3 cm |
0 |
|
treatment delay |
> 6 weeks |
1 |
|
|
<= 6 weeks |
0 |
|
Zubrod (ECOG) performance score |
2, 3 or 4 |
1 |
|
|
0 or 1 |
0 |
number of risk factors present =
= SUM(number of 7 risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7, plus extracapsular nodal extension
• Extracapsular nodal extension is a dominant risk factor, with the other factors being important in patients without extracapsular extension.
|
Number of Risk Factors |
Probability of Being Disease Free at 5 Years |
|
0 or 1 |
92% |
|
2 or 3 |
84% |
|
>= 4 |
50% |
|
extracapsular extension |
60% |
from Figure 3, page 9
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
