Improved survival in XXXX with @entity135 in the 1990s.

@entity1 @entity135 @entity5 @entity957 @entity1778 @entity1442
It is generally felt amongst the medical profession and the lay public that @entity5 is being treated more successfully than in the past. This is certainly true for childhood @entity5 and @entity1778 but evidence that significantly improved survival is occurring in the common solid @entity5 is lacking. Since 1963 the University of Liverpool Department of Otolaryngology/Head and Neck Surgery has collected data on all @entity1 with @entity135 presenting to the department. The present study investigates @entity1 with histologically proven @entity957 of the four main sites: larynx, hypopharynx, oral cavity and oropharynx. From 1963 until the end of 1989, 2738 @entity1 were seen by the department and from 1990 a further 717 @entity1 have been seen. Since 1990 @entity1 have tended to be in better general physical condition but, on the other hand, have tended to have more @entity1442 at the primary site. The department has latterly tended to see fewer @entity5 and more @entity5 of the oropharynx. Significantly fewer @entity1 have presented with neck node metastases. Multiple logistic regression suggests that the most significant difference between the two groups is the great reduction in neck node recurrence rates in the group of @entity1 seen since 1990 (P = 0.0001). The recurrence of @entity5 at the primary site since 1990 has been 35% compared with 41% before 1990, and recurrence in the neck nodes since 1990 has been 12%, compared with 15% before 1990. These differences are significant (P = 0.0141 and P = 0.0494, respectively). When studying survival in the 1960s, 1970s and 1980s, the 5-year cure rate was 50%, whereas since 1990 the figure has risen to 60% @entity5 -specific 5-year survival--a significant difference. A similar effect was noted in observed survival. This improvement in cure rate occurred for all four main sites. The results were confirmed by Cox's proportional hazards model where year of treatment was highly significantly associated with improved survival (P = 0.0001). It has been demonstrated that locoregional recurrence has improved since 1990 and this is reflected in improved survival figures. Although there are differences in the parameters of @entity5 referred before 1990 and since 1990, multivariate analysis suggests that the improvement in neck node recurrence rates may be responsible for this improved survival rate. Multivariate analysis for survival also suggests that the improvement in cure rates is independent of compounding variables and dependent on the year of presentation of the @entity5 . This improved survival may be related to factors, such as the administration of radical postoperative radiotherapy.
