Prognostic variables in head and neck cancer. Tumor site, stage, nodal status, differentiation, and immune status.

Currently the best prognostic indicator of cancer response is that of staging by the American Joint Commission Staging System. This system is most helpful in state I and in stage IV patients as a prognosticator. Caution must be exercised in oral cavity stage I cancers which tend to be more threatening and where further staging techniques should be used. The major need for careful prognostic indicators beyond simple staging is clearly evident in the stage II and stage III group. In this group, the histologic criteria of Jakobsson, the nuclear criteria suggested by Holm, and the immunologic staging parameters discussed here will hopefully better predict survival, and more importantly, guide therapy. Finally, the role of induction chemotherapy as a prognostic indicator itself has great potential and is currently being heavily investigated.