In-depth evaluation of the AJCC/UICC 1997 staging system of XXXX : prognostic homogeneity and proposed refinements.

@entity1 @entity932 @entity5 @entity189 @entity3
PURPOSE: To critically evaluate the American Joint Commission on @entity5 (AJCC)/International Union Against @entity5 (UICC) 1997 staging system and look back on its achievements by comparing it with the AJCC/UICC 1992 and Ho 1978 staging systems. To identify areas for additional refinement, we analyzed the prognostic heterogeneity within each stage in depth, which provided important clues for the addition or better categorization of the different defining criteria. METHODS AND MATERIALS: We performed a retrospective review of the data from 1294 consecutive biopsy-proven nonmetastatic @entity189 @entity1 and staged the extent of disease according to the defining criteria of the three staging systems. All @entity1 had undergone detailed pretreatment assessment by fiberoptic endoscopy and CT. Radical-intent radiotherapy was given using the Ho technique according to our standard protocol. RESULTS: The AJCC/UICC 1997 staging system was superior to the other two staging systems, because it assigned @entity1 to more uniform-size stage groupings and correlated better with prognosis. Parapharyngeal space involvement was not an independent predictor for survival, local control, or @entity3 . On the other hand, carotid space involvement correlated with a greater likelihood of @entity3 . Prognostic heterogeneity was found. Those with orbit, cranial nerve, or @entity932 fared worse within Stage T4; those with a maximal lymph node size >3 cm fared worse within Stage N2; and those with bilateral lymph node @entity3 fared worse within Stage N3. CONCLUSION: The prognostic accuracy of the AJCC/UICC 1997 staging system can be improved further by recategorization of the T, N, and group stage criteria.
