Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival
Introduction: TNM staging plays a central role in therapeutic decision-making, being also useful for estimating prognosis. Clinical staging (cTNM) is based on physical examination, endoscopy e imaging studies. Pathological staging (pTNM) is based on histopathological analysis after the surgical pro...
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Portuguese Society of Otolaryngology and Head and Neck Surgery
2021-06-01
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| Series: | Revista Portuguesa Otorrinolaringologia e Cirurgia de Cabeça e Pescoço |
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| Online Access: | https://journalsporl.com/index.php/sporl/article/view/2866 |
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| author | António Fontes Lima Filipa Carvalho Moreira Cátia Azevedo Isabel Costa Fernando Milhazes Mar Miguel Sá Breda Nuno Ribeiro Costa Luís Dias |
| author_facet | António Fontes Lima Filipa Carvalho Moreira Cátia Azevedo Isabel Costa Fernando Milhazes Mar Miguel Sá Breda Nuno Ribeiro Costa Luís Dias |
| author_sort | António Fontes Lima |
| collection | DOAJ |
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Introduction: TNM staging plays a central role in therapeutic decision-making, being also useful for estimating prognosis. Clinical staging (cTNM) is based on physical examination, endoscopy e imaging studies. Pathological staging (pTNM) is based on histopathological analysis after the surgical procedure. Discrepancies between cTNM and pTNM in larynx cancer have been reported in the literature, but some controversies remain.
Material and methods: a retrospective analysis of the patients who underwent surgery for larynx cancer (LC) in Hospital de Braga between January of 2013 and December of 2017 was performed. Patients who underwent total laryngectomy (TL) and partial laryngectomy (PL) associated with neck dissection. The following data were retrieved: age, gender, location, cTNM, and pTNM, time between first histopathological diagnosis and surgery, 5-year overall survival (OS), relapse, and death. For analysis purposes, the staging was performed according to American Joint Committee on Cancer 8th Edition, 2017.
Results: of the 72 patients diagnosed with LC, 47 were included in the analysis. 17% (n=8) underwent PL, while 83% (n=39) underwent TL. There was a discrepancy between cTNM and pTNM in 66% of the patients: a different T in 44,7%, with a low Cohen Kappa coefficient of 0,310 (p = 0,01), and a different N in 29,8%, with a substantial Cohen Kappa coefficient of 0,688 (p < 0,001). The most common reason for upstaging T was the invasion of the outer cortex of the thyroid cartilage, and the most frequent reason for downstaging was apparent vocal cord fixation in the preoperative examination. The median of the days between histopathological diagnosis and surgery in the patients whose T was upstaged was significantly different (superior) than other patients. Tumors located in the glottis were associated with a T downstaging (p = 0,020). There was no statistically significant difference in survival curves between patients with and without discrepancies in cTNM and pTNM.
Discussion and conclusions: our results show higher rates of re-staging than the ones described in the literature, that vary between 20 and 55%. New evaluation methods, such as imaging studies with better diagnostic accuracy, and, on the other hand, reducing the time between first diagnosis and surgical treatment may be important to reduce the rates of discrepancy between cTNM and pTNM. Despite re-staging being frequent, according to our data, it is not associated with worse OS.
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| format | Article |
| id | doaj-art-e8fd1e9c2aed4b3488e55dbbfab89cf4 |
| institution | Kabale University |
| issn | 2184-6499 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Portuguese Society of Otolaryngology and Head and Neck Surgery |
| record_format | Article |
| series | Revista Portuguesa Otorrinolaringologia e Cirurgia de Cabeça e Pescoço |
| spelling | doaj-art-e8fd1e9c2aed4b3488e55dbbfab89cf42025-08-20T03:29:28ZengPortuguese Society of Otolaryngology and Head and Neck SurgeryRevista Portuguesa Otorrinolaringologia e Cirurgia de Cabeça e Pescoço2184-64992021-06-0159210.34631/sporl.853Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survivalAntónio Fontes Lima0Filipa Carvalho Moreira1Cátia Azevedo2Isabel Costa3Fernando Milhazes Mar4Miguel Sá Breda5Nuno Ribeiro Costa6Luís Dias7Hospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, PortugalHospital de Braga, Portugal Introduction: TNM staging plays a central role in therapeutic decision-making, being also useful for estimating prognosis. Clinical staging (cTNM) is based on physical examination, endoscopy e imaging studies. Pathological staging (pTNM) is based on histopathological analysis after the surgical procedure. Discrepancies between cTNM and pTNM in larynx cancer have been reported in the literature, but some controversies remain. Material and methods: a retrospective analysis of the patients who underwent surgery for larynx cancer (LC) in Hospital de Braga between January of 2013 and December of 2017 was performed. Patients who underwent total laryngectomy (TL) and partial laryngectomy (PL) associated with neck dissection. The following data were retrieved: age, gender, location, cTNM, and pTNM, time between first histopathological diagnosis and surgery, 5-year overall survival (OS), relapse, and death. For analysis purposes, the staging was performed according to American Joint Committee on Cancer 8th Edition, 2017. Results: of the 72 patients diagnosed with LC, 47 were included in the analysis. 17% (n=8) underwent PL, while 83% (n=39) underwent TL. There was a discrepancy between cTNM and pTNM in 66% of the patients: a different T in 44,7%, with a low Cohen Kappa coefficient of 0,310 (p = 0,01), and a different N in 29,8%, with a substantial Cohen Kappa coefficient of 0,688 (p < 0,001). The most common reason for upstaging T was the invasion of the outer cortex of the thyroid cartilage, and the most frequent reason for downstaging was apparent vocal cord fixation in the preoperative examination. The median of the days between histopathological diagnosis and surgery in the patients whose T was upstaged was significantly different (superior) than other patients. Tumors located in the glottis were associated with a T downstaging (p = 0,020). There was no statistically significant difference in survival curves between patients with and without discrepancies in cTNM and pTNM. Discussion and conclusions: our results show higher rates of re-staging than the ones described in the literature, that vary between 20 and 55%. New evaluation methods, such as imaging studies with better diagnostic accuracy, and, on the other hand, reducing the time between first diagnosis and surgical treatment may be important to reduce the rates of discrepancy between cTNM and pTNM. Despite re-staging being frequent, according to our data, it is not associated with worse OS. https://journalsporl.com/index.php/sporl/article/view/2866larynx cancer TNM staging |
| spellingShingle | António Fontes Lima Filipa Carvalho Moreira Cátia Azevedo Isabel Costa Fernando Milhazes Mar Miguel Sá Breda Nuno Ribeiro Costa Luís Dias Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival Revista Portuguesa Otorrinolaringologia e Cirurgia de Cabeça e Pescoço larynx cancer TNM staging |
| title | Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival |
| title_full | Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival |
| title_fullStr | Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival |
| title_full_unstemmed | Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival |
| title_short | Discrepancies between clinical and pathologic staging in tumors of the larynx: Evaluation of the probable causes and influence in overall survival |
| title_sort | discrepancies between clinical and pathologic staging in tumors of the larynx evaluation of the probable causes and influence in overall survival |
| topic | larynx cancer TNM staging |
| url | https://journalsporl.com/index.php/sporl/article/view/2866 |
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