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The current AJCC staging system for HCC is unnecessarily complex. We propose a simplified model of stratification that is based on vascular invasion, tumor number, and tumor size and incorporates the effect of fibrosis on survival.

Purpose The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram—a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials.

BACKGROUNDThe authors set out to assess the correlation between smoking‐related second primary tumor (SPT) development and cigarette smoking habits after diagnosis and definitive treatment in patients with early‐stage head and neck squamous cell carcinoma who were enrolled in a placebo‐controlled randomized chemoprevention trial of 13‐cis‐retinoic acid.METHODSLongitudinal data collected for 10 years after the index diagnosis are presented for 1190 patients. Cox proportional hazards regression models were used to examine the effects of changes in smoking behavior on smoking‐related SPT development.RESULTSOne‐third of all patients who quit smoking within 12 months before randomization experienced recurrence, compared with 6.9% and 10.4% of all never‐smokers and former smokers, respectively. Approximately 16% of all current smokers stopped smoking, and nearly 22% of current smokers developed SPTs, compared with 14.5%, 13.2%, and 8.8% of all recent smokers, former smokers, and never‐smokers, respectively. The probability of developing a smoking‐related SPT was highest among patients who were current smokers at randomization. These patients, regardless of whether they ceased smoking during follow‐up, were nearly three times more likely than patients who had never smoked to develop a smoking‐related SPT. In contrast, former smokers and recent quitters who continued to abstain from smoking during follow‐up were approximately 1.5 times more likely to develop an SPT compared with patients who had never smoked.CONCLUSIONSPatients who continue to smoke after the successful treatment of their index head and neck malignancies have a substantially higher risk of developing smoking‐related SPTs. Cancer 2004. © 2004 American Cancer Society.

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African-American patients had poorer survival outcomes, with race and age emerging as significant independent predictors of survival after treatment for oral and pharyngeal cancer, compared with their white counterparts. Primary and secondary prevention programs that target younger patients at high risk might reduce environmental risk factors such as smoking and alcohol consumption, which may play a greater role in the acquired susceptibility for oral and pharyngeal cancer in African-American males.