Prognostic significance of presentation-to-diagnosis interval in patients with oropharyngeal carcinoma

Objective: To evaluate the prognostic impact of presentation-to-diagnosis interval (PDI) and its association with other clinical factors in patients with oropharyngeal squamous cell carcinoma (OpSCC). Design: Retrospective cohort study. Setting: Otolaryngology clinic of an academic medical center. Patients: Eighty-seven patients with OpSCC referred to the otolaryngology service at the Johns Hopkins Medical Institutions from March 1994 to August 2001 were included in the study. Selection criteria included confirmed pathological diagnosis of OpSCC, availability of referral record for PDI determination, and no past history of oropharyngeal cancer. Main Outcome Measures: The PDI is defined as the time between the patient's first presentation to a medical professional for tumor-related symptoms and the time when the diagnosis of OpSCC was made. The prognostic impact of PDI and its association with other clinical factors were assessed using univariate and multivariate analyses. Results: Forty percent of patients (35/87) had a PDI of 3 months or longer. Referred otalgia, active smoking status at the time of diagnosis, stage IV disease, and advanced T stage were associated with a poor prognosis. Prolonged PDI itself was not associated with a significant decrease in survival in univariate analysis (hazard ratio, 1.27; P=.52). Furthermore, no significant correlation was found between PDI and N stage, T stage, young age at presentation (<45 years), or tobacco use. Conclusions: Difficulty in making the diagnosis of OpSCC is evident by the high proportion of patients with PDI of 3 months or longer. The PDI does not appear to have an impact on survival. Referred otalgia, widely recognized as a strong indicator of invasive head and neck cancer, portends a poor prognosis.