Impact of Comorbidity, Symptoms, and Patients' Characteristics on the Prognosis of Oral Carcinomas

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Abstract
APPROXIMATELY 30,000 new cases of oral cavity and pharynx cancer are diagnosed annually in the United States, which represents almost 3% of all tumors in men.1 Fifty-eight percent of these neoplasms are located in the tongue and in other parts of the mouth. In Brazil, 7950 new cases of mouth cancer were estimated in 1999.2 Early diagnosis is the best chance for an effective treatment, with aesthetic and functional satisfactory results. Surgery and radiotherapy are the primary modalities of treatment, and the choice of therapy depends on factors related to the tumor, to the patient, and to the institutional experience.3 The most important prognostic factor is the anatomical extension of the disease, described through the TNM staging system.4 Clinical characteristics of the patients, such as severity of the symptoms related to the cancer and medical comorbidities (defined as concomitant diseases not related to the disease under study), are important for therapeutic planning and for determining the risk of complications and the prognosis of several types of cancer.5-12 The addition of these factors to the traditional TNM staging system permitted the creation of new staging systems, superior in the prediction of survival when compared with the TNM staging system alone.6-8,13