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Original Investigation
August 2018

Association of Symptoms and Clinical Findings With Anticipated Outcomes in Patients With Recurrent Head and Neck Cancer

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Editor, JAMA Otolaryngology–Head & Neck Surgery
JAMA Otolaryngol Head Neck Surg. 2018;144(8):738-745. doi:10.1001/jamaoto.2018.1230
Key Points

Question  Are symptoms and clinical findings at the time of diagnosis of recurrent head and neck cancer associated with disease outcomes?

Findings  In this cohort study of 196 patients, 1-year overall survival was 58.2% (114 of 196 patients). The clinical variables of time to recurrence and symptom severity stage were combined with rTNM stage to create a new 3-category staging system; the discriminative power of this new composite staging was better than that of the American Joint Committee on Cancer classification.

Meaning  Symptoms and clinical variables may be associated with anticipation of outcomes in patients with recurrent head and neck cancer.


Importance  Despite advances in treatment over the last decades, recurrent head and neck cancer continues to have a poor prognosis. Prognostic accuracy may help in patient counseling.

Objective  To explore whether symptoms and clinical variables can predict prognosis in the setting of recurrent head and neck cancer.

Design, Setting, and Participants  In this retrospective cohort study, patients treated for head and neck cancer with curative intent at Siteman Cancer Center in St Louis, Missouri (a tertiary cancer center) between January 1, 2007, and December 31, 2014, were reviewed. The dates of data analysis were October 2016 to June 2017. Patients who developed a recurrent cancer were included, with 196 patients meeting inclusion criteria.

Main Outcomes and Measures  Symptoms and clinical findings at presentation of recurrence were recorded. Sequential sequestration and conjunctive consolidation (2 multivariable techniques) were used to create a composite staging system to predict 1-year overall survival (OS).

Results  Among 196 patients (mean [SD] age, 61 [11] years; 166 [84.7%] of white race/ethnicity; 76.5% male), 1-year OS was 58.2% (114 of 196 patients). Time to recurrence, symptom severity stage, and rTNM stage were consolidated into a 3-category Clinical Severity Staging System, with 1-year OS rates of 90.2% (95% CI, 82.7%-97.6%) for the 61 patients classified as A, 58.1% (95% CI, 47.7%-68.6%) for the 86 patients classified as B, and 18.4% (95% CI, 7.5%-29.2%) for the 49 patients classified as C. The discriminative power of the new composite staging was better than that of the American Joint Committee on Cancer classification (C = 0.79 vs C = 0.66).

Conclusions and Relevance  These findings suggest that clinical variables are associated with anticipated outcomes in patients with recurrent head and neck cancer.