Perioperative complications, comorbidities, and survival in oral or oropharyngeal cancer

Objectives: To establish the value of clinical factors in the prediction of perioperative complications and death in patients with oral and oropharyngeal carcinomas and to develop a new extended clinical severity staging system that combines patient and tumor factors. Patients and Methods: A total of 530 patients with oral or oropharyngeal carcinomas submitted to surgical treatment were studied. Logistic regression was used to identify risk factors for perioperative complications, and the Cox proportional hazards regression model was used to establish independent prognostic factors. Results: Daily alcohol consumption, smoking, sex, neck lump, earache, pain, dysphagia, weight loss, oral bleeding, odynophagia, body mass index, National Cancer Institute comorbidity index score, American Society of Anesthesiologists surgical risk, hematocrit level, and total lymphocyte count had an impact on prognosis in univariate analysis. Survival according to extended clinical severity stage was 76.7% for stage 1, 64.4% for stage 2, 44.8% for stage 3, and 25.5% for stage 4 (chi(2) = 64.16; P<.001). In multivariate analysis, only APACHE II score, neck dissection, POSSUM index score, and type of reconstruction were independent risk factors for perioperative complications. The final prognostic model included development of local plus systemic complications, extended clinical severity stage, type of reconstruction, and APACHE II score. Conclusions: Clinical variables have a predictive effect on morbidity and mortality of patients with oral and oropharyngeal cancer treated surgically. Local plus systemic perioperative complications can adversely affect the prognosis. The uniformity of results confirms that survival estimates can be enhanced by the addition of clinical characteristics to the TNM classification, creating a more accurate system for the estimation of prognosis.