Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Head and Neck Cancer Staging and Prognosis: Perspectives of the UICC and the AJCC

  • Chapter
  • First Online:
Head and Neck Cancer

Abstract

The prognosis of head and neck cancer embodies numerous dimensions of outcome governed by a large array of factors within the patient and the tumor. These can be influenced by external factors that include access to an adequate standard of treatment for these tumors. For many outcomes, especially the key end-points of organ preservation, loco-regional control, occurrence of distant metastases, and survival, anatomic extent of disease remains one of the most powerful prognostic factors. This is embodied in the tumor-node-metastasis (TNM) classification which has provided a very effective enabling tool to facilitate many elements of cancer control. Traditionally, its contribution has been a ­codified classification and language to describe anatomic stage of disease for use in the clinic, determining eligibility and stratification for clinical trials and treatment protocols, and for comparison and surveillance of treatment results among centers and jurisdictions. More recently, a focus on nonanatomic factors has become very important, partly because it is recognized that traditional extent of disease does not embrace all dimensions of prognosis. In particular, this relates to the quest to understand the biological dimensions of cancer that are needed to achieve more personalized and/or biologically driven therapies. Increasingly, there is a need in head and neck cancer to exploit new biological discoveries to permit modification of treatment and interventions in the clinic for this heterogeneous group of tumors. Because of this, the TNM has been criticized due to a perception that it has not been adapted sufficiently to modern needs despite its worldwide adoption. This may stem from the fact that there is no alternative uniform functional framework available to classify nonanatomical predictive and prognostic factors. There seems to be a tendency to regard TNM as the optimal receptacle for these factors due to its uniform appeal and success. As the field evolves, both anatomic disease extent and other factors, especially those addressing biological behavior of disease, need to be ­studied in their component domains as well as in combination using an agreed enabling taxonomy. An important strategy is to move toward constructing prognostic models, likely using prognostic nomograms, which will not only include the TNM staging information, but will also include other parameters of prognosis including comorbidities and biochemical or genetic markers. In addition, experts in one area (e.g., translational science or clinical trials methodology perhaps) who may rely on TNM may not always consider that the classification provides very different needs for others (e.g., health services research or screening and cancer control initiatives, etc.) and vice versa. Ignoring or dismissing one ­dimension of prognosis compared to another will not be fruitful and the true contribution of each will remain ­unappreciated, and the goals of the prognostic factor effort in head and neck cancer may be left unfulfilled.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  2. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2010.

    Google Scholar 

  3. Greene FL, Sobin LH. The TNM system: our language for cancer care. J Surg Oncol. 2002;80(3):119–20.

    Article  PubMed  Google Scholar 

  4. Denoix PF. Tumor, node and metastasis (TNM). Bull Inst Nat Hyg (Paris). 1944;1:1–69.

    Google Scholar 

  5. International Union Against Cancer (UICC). TNM classification of malignant tumours. Geneva: G. de Buren; 1968.

    Google Scholar 

  6. International Union Against Cancer (UICC). TNM classification of malignant tumours. 2nd ed. Geneva: Imprimerie G. de Buren; 1974.

    Google Scholar 

  7. Mackillop WJ, O’Sullivan B, Gospodarowicz M. The role of cancer staging in evidence-based medicine. Cancer Prev Control. 1998;2(6):269–77.

    PubMed  CAS  Google Scholar 

  8. NCCN. National Comprehensive Cancer Network – Head and Neck. http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf. Accessed June 2009.

  9. Ferlito A, Rinaldo A. The future of the TNM staging system in laryngeal cancer: time for a debate? Eur Arch Otorhinolaryngol. 2008;265(12):1441–3.

    Article  PubMed  Google Scholar 

  10. Shah J. Concerning the editorial “The future of the TNM staging system in laryngeal cancer: time for a debate?” by Ferlito and Rinaldo. Eur Arch Otorhinolaryngol. 2009;266(1):155. author reply 157–158.

    Article  PubMed  Google Scholar 

  11. Gospodarowicz MK, Miller D, Groome PA, Greene FL, Logan PA, Sobin LH. The process for continuous improvement of the TNM classification. Cancer. 2004;100(1):1–5.

    Article  PubMed  Google Scholar 

  12. Wittekind C, Greene F, Hutter RVP, Sobin LH, Henson DE. TNM supplement: a commentary on uniform use. 3rd ed. New York: Wiley; 2003.

    Book  Google Scholar 

  13. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  14. Shaw RJ, Lowe D, Woolgar JA, et al. Extracapsular spread in oral squamous cell carcinoma. Head Neck. 2010;32(6):714–22.

    PubMed  Google Scholar 

  15. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27(10):843–50.

    Article  PubMed  Google Scholar 

  16. Huang SH, Hwang D, Lockwood G, Goldstein DP, O’Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a meta-analysis of reported studies. Cancer. 2009;115(7):1489–97.

    Article  PubMed  CAS  Google Scholar 

  17. Brierley JD, Greene FL, Sobin LH, Wittekind C. The “y” symbol: an important classification tool for neoadjuvant cancer treatment. Cancer. 2006;106(11):2526–7.

    Article  PubMed  Google Scholar 

  18. Atula T, Hunter KD, Cooper LA, Shoaib T, Ross GL, Soutar DS. Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma. Eur J Surg Oncol. 2009;35(5):532–8.

    PubMed  CAS  Google Scholar 

  19. Greene FL, Page D, Norrow M, et al. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.

    Book  Google Scholar 

  20. Sobin LH, Wittekind C. TNM classification of malignant tumors. 6th ed. New York: Wiley; 2002.

    Google Scholar 

  21. Yousem DM, Gad K, Tufano RP. Resectability issues with head and neck cancer. AJNR Am J Neuroradiol. 2006;27(10):2024–36.

    PubMed  CAS  Google Scholar 

  22. Liao CT, Ng SH, Chang JT, et al. T4b oral cavity cancer below the mandibular notch is resectable with a favorable outcome. Oral Oncol. 2007;43(6):570–9.

    Article  PubMed  Google Scholar 

  23. Nishioka T, Shirato H, Kagei K, et al. Skull-base invasion of nasopharyngeal carcinoma: magnetic resonance imaging findings and therapeutic implications. Int J Radiat Oncol Biol Phys. 2000;47(2):395–400.

    Article  PubMed  CAS  Google Scholar 

  24. Lee AW, Au JS, Teo PM, et al. Staging of nasopharyngeal carcinoma: suggestions for improving the current UICC/AJCC Staging System. Clin Oncol (R Coll Radiol). 2004;16(4):269–76.

    CAS  Google Scholar 

  25. Liu MZ, Tang LL, Zong JF, et al. Evaluation of sixth edition of AJCC staging system for nasopharyngeal carcinoma and proposed improvement. Int J Radiat Oncol Biol Phys. 2008;70(4):1115–23.

    Article  PubMed  Google Scholar 

  26. Tang L, Li L, Mao Y, et al. Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging: prognostic value and staging categories. Cancer. 2008;113(2):347–54.

    Article  PubMed  Google Scholar 

  27. Tham IW, Hee SW, Yap SP, Tuan JK, Wee J. Retropharyngeal nodal metastasis related to higher rate of distant metastasis in patients with N0 and N1 nasopharyngeal cancer. Head Neck. 2009;31(4):468–74.

    Article  PubMed  Google Scholar 

  28. Ch’ng S, Maitra A, Allison RS, et al. Parotid and cervical nodal status predict prognosis for patients with head and neck metastatic cutaneous squamous cell carcinoma. J Surg Oncol. 2008;98(2):101–5.

    Article  PubMed  Google Scholar 

  29. Teppo H, Kervinen J, Koivunen P, Alho OP. Incidence and outcome of head and neck mucosal melanoma – a population-based survey from Northern Finland. Int J Circumpolar Health. 2006;65(5):443–7.

    PubMed  Google Scholar 

  30. Ludwig JA, Weinstein JN. Biomarkers in cancer staging, prognosis and treatment selection. Nat Rev Cancer. 2005;5(11):845–56.

    Article  PubMed  CAS  Google Scholar 

  31. Gospodarowicz MK, O’Sullivan B, Koh E-S. Prognostic factors: principles and application. In: Gospodarowicz MK, O’Sullivan B, Sobin LH, editors. Prognostic factors in cancer. 3rd ed. New York: Wiley; 2006. p. 23–38.

    Google Scholar 

  32. Bourhis J. Oral cavity, pharynx, and larynx cancer. In: Gospodarowicz MK, O’Sullivan B, Sobin LH, editors. Prognostic factors in cancer. 3rd ed. New York: Wiley; 2006. p. 99–104.

    Google Scholar 

  33. Hodul PJ, Yeatman TJ. TNM staging is obsolete. J Surg Oncol. 2007;95(1):8–9.

    Article  PubMed  Google Scholar 

  34. Giri U, Ashorn CL, Ramdas L, et al. Molecular signatures associated with clinical outcome in patients with high-risk head-and-neck squamous cell carcinoma treated by surgery and radiation. Int J Radiat Oncol Biol Phys. 2006;64(3):670–7.

    Article  PubMed  CAS  Google Scholar 

  35. Kong CS, Narasimhan B, Cao H, et al. The relationship between human papillomavirus status and other molecular prognostic markers in head and neck squamous cell carcinomas. Int J Radiat Oncol Biol Phys. 2009;74(2):553–61.

    Article  PubMed  CAS  Google Scholar 

  36. Kumar B, Cordell KG, Lee JS, et al. EGFR, p16, HPV Titer, Bcl-xL and p53, sex, and smoking as indicators of response to therapy and survival in oropharyngeal cancer. J Clin Oncol. 2008;26(19):3128–37.

    Article  PubMed  Google Scholar 

  37. Takes RP, Rinaldo A, Rodrigo JP, Devaney KO, Fagan JJ, Ferlito A. Can biomarkers play a role in the decision about treatment of the clinically negative neck in patients with head and neck cancer? Head Neck. 2008;30(4):525–38.

    Article  PubMed  Google Scholar 

  38. Ang KK, Berkey BA, Tu X, et al. Impact of epidermal growth factor receptor expression on survival and pattern of relapse in patients with advanced head and neck carcinoma. Cancer Res. 2002;62(24):7350–6.

    PubMed  CAS  Google Scholar 

  39. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11(1):21–8.

    Article  PubMed  CAS  Google Scholar 

  40. Kim S, Grandis JR, Rinaldo A, Takes RP, Ferlito A. Emerging perspectives in epidermal growth factor receptor targeting in head and neck cancer. Head Neck. 2008;30(5):667–74.

    Article  PubMed  Google Scholar 

  41. Egloff AM, Grandis JR. Improving response rates to EGFR-targeted therapies for head and neck squamous cell carcinoma: candidate predictive biomarkers and combination treatment with Src inhibitors. J Oncol. 2009;2009:896407.

    PubMed  Google Scholar 

  42. Mehanna H, Jones TM, Gregoire V, Ang KK. Oropharyngeal carcinoma related to human papillomavirus. BMJ. 2010;340:879–80.

    Article  Google Scholar 

  43. Hammarstedt L, Lindquist D, Dahlstrand H, et al. Human papillomavirus as a risk factor for the increase in incidence of tonsillar cancer. Int J Cancer. 2006;119(11):2620–3.

    Article  PubMed  CAS  Google Scholar 

  44. Klussmann JP, Mooren JJ, Lehnen M, et al. Genetic signatures of HPV-related and unrelated oropharyngeal carcinoma and their prognostic implications. Clin Cancer Res. 2009;15(5):1779–86.

    Article  PubMed  CAS  Google Scholar 

  45. Goldenberg D, Begum S, Westra WH, et al. Cystic lymph node metastasis in patients with head and neck cancer: an HPV-associated phenomenon. Head Neck. 2008;30(7):898–903.

    Article  PubMed  Google Scholar 

  46. Straetmans JM, Olthof N, Mooren JJ, de Jong J, Speel EJ, Kremer B. Human papillomavirus reduces the prognostic value of nodal involvement in tonsillar squamous cell carcinomas. Laryngoscope. 2009;119(10):1951–7.

    Article  PubMed  Google Scholar 

  47. Settle K, Posner MR, Schumaker LM, et al. Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients. Cancer Prev Res (Phila Pa). 2009;2(9):776–81.

    Article  Google Scholar 

  48. Maxwell JH, Kumar B, Feng FY, et al. Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence. Clin Cancer Res. 2010;16(4):1226–35.

    Article  PubMed  CAS  Google Scholar 

  49. Lo YM. Prognostic implication of pretreatment plasma/serum concentration of Epstein-Barr virus DNA in nasopharyngeal carcinoma. Biomed Pharmacother. 2001;55(7):362–5.

    Article  PubMed  CAS  Google Scholar 

  50. Chan KC, Lo YM. Circulating EBV DNA as a tumor marker for nasopharyngeal carcinoma. Semin Cancer Biol. 2002;12(6):489–96.

    Article  PubMed  CAS  Google Scholar 

  51. Leung SF, Zee B, Ma BB, et al. Plasma Epstein-Barr viral deoxyribonucleic acid quantitation complements tumor-node-metastasis staging prognostication in nasopharyngeal carcinoma. J Clin Oncol. 2006;24(34):5414–8.

    Article  PubMed  CAS  Google Scholar 

  52. Schlumberger M, Hitzel A, Toubert ME, et al. Comparison of seven serum thyroglobulin assays in the follow-up of papillary and follicular thyroid cancer patients. J Clin Endocrinol Metab. 2007;92(7):2487–95.

    Article  PubMed  CAS  Google Scholar 

  53. McLeod DS. Current concepts and future directions in differentiated thyroid cancer. Clin Biochem Rev. 2010;31(1):9–19.

    PubMed  Google Scholar 

  54. Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab. 2010;95(6):2655–63.

    Google Scholar 

  55. Boostrom SY, Grant CS, Thompson GB, et al. Need for a revised staging consensus in medullary thyroid carcinoma. Arch Surg. 2009;144(7):663–9.

    Article  PubMed  Google Scholar 

  56. Chong VF. Tumour volume measurement in head and neck cancer. Cancer Imaging. 2007;7 Spec No A:S47–49.

    Google Scholar 

  57. Studer G, Lutolf UM, El-Bassiouni M, Rousson V, Glanzmann C. Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol. 2007;46(3):386–94.

    Article  PubMed  CAS  Google Scholar 

  58. Chong VF, Ong CK. Nasopharyngeal carcinoma. Eur J Radiol. 2008;66(3):437–47.

    Article  PubMed  CAS  Google Scholar 

  59. King AD, Zee B, Yuen EH, et al. Nasopharyngeal cancers: which method should be used to measure these irregularly shaped tumors on cross-sectional imaging? Int J Radiat Oncol Biol Phys. 2007;69(1):148–54.

    Article  PubMed  Google Scholar 

  60. Lee CC, Ho HC, Su YC, et al. Bidimensional measurement of nasopharyngeal carcinoma: a simple method to predict outcomes. Clin Otolaryngol. 2009;34(1):26–33.

    Article  PubMed  Google Scholar 

  61. Saglam O, Shah V, Worsham MJ. Molecular differentiation of early and late stage laryngeal squamous cell carcinoma: an exploratory analysis. Diagn Mol Pathol. 2007;16(4):218–21.

    Article  PubMed  CAS  Google Scholar 

  62. Jones S, Chen WD, Parmigiani G, et al. Comparative lesion sequencing provides insights into tumor evolution. Proc Natl Acad Sci USA. 2008;105(11):4283–8.

    Article  PubMed  CAS  Google Scholar 

  63. Geurts TW, Nederlof PM, van den Brekel MW, et al. Pulmonary squamous cell carcinoma following head and neck squamous cell carcinoma: metastasis or second primary? Clin Cancer Res. 2005;11(18):6608–14.

    Article  PubMed  Google Scholar 

  64. Leong PP, Rezai B, Koch WM, et al. Distinguishing second primary tumors from lung metastases in patients with head and neck squamous cell carcinoma. J Natl Cancer Inst. 1998;90(13):972–7.

    Article  PubMed  CAS  Google Scholar 

  65. Johansen LV, Grau C, Overgaard J. Laryngeal carcinoma – multivariate analysis of prognostic factors in 1252 consecutive patients treated with primary radiotherapy. Acta Oncol. 2003;42(7):771–8.

    Article  PubMed  Google Scholar 

  66. Guntinas-Lichius O, Wendt T, Buentzel J, et al. Head and neck cancer in Germany: a site-specific analysis of survival of the Thuringian cancer registration database. J Cancer Res Clin Oncol. 2009.

    Google Scholar 

  67. Hannisdal K, Schjolberg A, De Angelis PM, Boysen M, Clausen OP. Human papillomavirus (HPV)-positive tonsillar carcinomas are frequent and have a favourable prognosis in males in Norway. Acta Otolaryngol. 2010;130(2):293–9.

    Article  PubMed  CAS  Google Scholar 

  68. Dahlstrand H, Dahlgren L, Lindquist D, Munck-Wikland E, Dalianis T. Presence of human papillomavirus in tonsillar cancer is a favourable prognostic factor for clinical outcome. Anticancer Res. 2004;24(3b):1829–35.

    PubMed  Google Scholar 

  69. Datema FR, Ferrier MB, van der Schroeff MP, Baatenburg de Jong RJ. Impact of comorbidity on short-term mortality and overall survival of head and neck cancer patients. Head Neck. 2010;32(6):728–36.

    PubMed  Google Scholar 

  70. Piccirillo JF, Feinstein AR. Clinical symptoms and comorbidity: significance for the prognostic classification of cancer. Cancer. 1996;77(5):834–42.

    Article  PubMed  CAS  Google Scholar 

  71. Homma A, Sakashita T, Oridate N, et al. Importance of comorbidity in hypopharyngeal cancer. Head Neck. 2010;32(2):148–53.

    PubMed  Google Scholar 

  72. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–6.

    PubMed  CAS  Google Scholar 

  73. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluation the outcome of diabetes mellitus. J Chronic Dis. 1974;27(7–8):387–404.

    Article  PubMed  CAS  Google Scholar 

  74. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  PubMed  CAS  Google Scholar 

  75. Cleary PD, Greenfield S, Mulley AG, et al. Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA. 1991;266(1):73–9.

    Article  PubMed  CAS  Google Scholar 

  76. Hall SF, Rochon PA, Streiner DL, Paszat LF, Groome PA, Rohland SL. Measuring comorbidity in patients with head and neck cancer. Laryngoscope. 2002;112(11):1988–96.

    Article  PubMed  Google Scholar 

  77. Castro MA, Dedivitis RA, Ribeiro KC. Comorbidity measurement in patients with laryngeal squamous cell carcinoma. ORL J Otorhinolaryngol Relat Spec. 2007;69(3):146–52.

    Article  PubMed  Google Scholar 

  78. Peters LJ, O’Sullivan B, Giralt J, et al. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol. 2010;28(18):2996–3001.

    Article  PubMed  Google Scholar 

  79. Guadagnolo BA, Liu C-C, Cormier JN, Du XL. Evaluation of trends in the use of intensity-modulated radiotherapy for head and neck cancer from 2000 through 2005: socioeconomic disparity and geographic variation in a large population-based cohort. Cancer. 2010;116(14):3505–12.

    Google Scholar 

  80. Chen AY, Schrag NM, Halpern M, Stewart A, Ward EM. Health insurance and stage at diagnosis of laryngeal cancer: does insurance type predict stage at diagnosis? Arch Otolaryngol Head Neck Surg. 2007;133(8):784–90.

    Article  PubMed  Google Scholar 

  81. Chen AY, Schrag NM, Halpern MT, Ward EM. The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. Cancer. 2007;110(2):395–402.

    Article  PubMed  Google Scholar 

  82. Greenlee RT, Howe HL. County-level poverty and distant stage cancer in the United States. Cancer Causes Control. 2009;20(6):989–1000.

    Article  PubMed  Google Scholar 

  83. Kwok J, Langevin SM, Argiris A, Grandis JR, Gooding WE, Taioli E. The impact of health insurance status on the survival of patients with head and neck cancer. Cancer. 2009;116(2):476–85.

    Article  Google Scholar 

  84. Molina MA, Cheung MC, Perez EA, et al. African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients. Cancer. 2008;113(10):2797–806.

    Article  PubMed  Google Scholar 

  85. Hall SF, Groome PA, Irish J, O’Sullivan B. TNM-based stage groupings in head and neck cancer: application in cancer of the hypopharynx. Head Neck. 2009;31(1):1–8.

    Article  PubMed  Google Scholar 

  86. Patel SG, Lydiatt WM. Staging of head and neck cancers: is it time to change the balance between the ideal and the practical? J Surg Oncol. 2008;97(8):653–7.

    Article  PubMed  Google Scholar 

  87. Poorten VV, Hart A, Vauterin T, et al. Prognostic index for patients with parotid carcinoma: international external validation in a Belgian-German database. Cancer. 2009;115(3):540–50.

    Article  PubMed  Google Scholar 

  88. Vander Poorten VL, Hart AA, van der Laan BF, et al. Prognostic index for patients with parotid carcinoma: external validation using the nationwide 1985–1994 Dutch Head and Neck Oncology Cooperative Group database. Cancer. 2003;97(6):1453–63.

    Article  PubMed  Google Scholar 

  89. Toh CK, Heng D, Ong YK, Leong SS, Wee J, Tan EH. Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma. Br J Cancer. 2005;92(8):1382–7.

    Article  PubMed  Google Scholar 

  90. Gross ND, Patel SG, Carvalho AL, et al. Nomogram for deciding adjuvant treatment after surgery for oral cavity squamous cell carcinoma. Head Neck. 2008;30(10):1352–60.

    Article  PubMed  Google Scholar 

  91. Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 2008;26(8):1364–70.

    Article  PubMed  Google Scholar 

  92. Harrell Jr FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.

    Article  PubMed  Google Scholar 

  93. Justice AC, Covinsky KE, Berlin JA. Assessing the generalizability of prognostic information. Ann Intern Med. 1999;130(6):515–24.

    PubMed  CAS  Google Scholar 

  94. Groome PA, Schulze KM, Mackillop WJ, et al. A comparison of published head and neck stage groupings in carcinomas of the tonsillar region. Cancer. 2001;92(6):1484–94.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Head and Neck Oncology Program, Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Brian O’Sullivan

Authors
  1. Brian O’Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jatin P. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian O’Sullivan .

Editor information

Editors and Affiliations

  1. , Dept of Radio-Oncology, Genolier Swiss Medical Network, 4 Route du Muids, Genolier, CH-1272, Switzerland

    Jacques Bernier

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

O’Sullivan, B., Shah, J.P. (2011). Head and Neck Cancer Staging and Prognosis: Perspectives of the UICC and the AJCC. In: Bernier, J. (eds) Head and Neck Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9464-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-9464-6_8

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-9463-9

  • Online ISBN: 978-1-4419-9464-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation