Pugliano et al developed a clinical severity staging system to help predict the prognosis for patients with carcinomas of the oral cavity. The authors are from Washington University School of Medicine in St. Louis, Missouri.
Parameters:
(1) symptom severity related to the cancer
(2) comorbidity
(3) TNM staging
Severity of the symptoms related to cancer is graded as:
(1) none
(2) mild
(3) moderate
(4) severe
Comorbidity caused by disease unrelated to the cancer is classified using the Kaplan-Feinstein index. A prognostically significant comorbidity (one likely to significantly reduce a patient's life expectancy) involved an index value of 3, which may include:
(1) congestive heart failure
(2) acute myocardial infarction within the past 6 months
(3) recent stroke
(4) severely decompensated alcoholism (2 or more alcoholic seizures or episodes of delirium tremens)
(5) being too ill to tolerate chemotherapy
The tumor extent was classified using the stages of the TNM system:
(1) Stage I (T1 N0 M0)
(2) Stage II (T2 N0 M0)
(3) Stage III (T3 N0 M0, T1-T3 N1 M0)
(4) Stage IV (T4, N2, N3 or M1)
Symptom severity and comorbidity are combined into the functional severity stage:
|
Symptom Severity |
Comorbidity |
Functional Severity |
|
none |
absent |
alpha |
|
mild |
absent |
beta |
|
moderate or severe |
absent |
gamma |
|
none to severe |
present |
gamma |
The functional severity and tumor stage were combined into the clinical severity stage:
|
Functional Severity |
Tumor Stage |
Clinical Severity |
|
alpha |
Stage I |
A |
|
alpha |
Stage II |
B |
|
beta |
Stage I or II |
B |
|
alpha |
Stage III or IV |
C |
|
beta |
Stage III or IV |
C |
|
gamma |
Stage I to IV |
D |
|
Clinical Severity Stage |
5 Year Survival |
|
A |
77% |
|
B |
56% |
|
C |
42% |
|
D |
14% |
from Table 7, page 42, Pugliano et al 1999.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
