Matthias Kreppel1, Parvin Nazarli2, Andrea Grandoch2, Ali-Farid Safi2, Matthias Zirk2, Hans-Joachim Nickenig2, Martin Scheer3, Daniel Rothamel2, Martin Hellmich4, Joachim E Zöller2. 1. Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center for Integrated Oncology (CIO) Cologne-Bonn, Germany. Electronic address: mattheskreppel@yahoo.de. 2. Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center for Integrated Oncology (CIO) Cologne-Bonn, Germany. 3. Mühlenkreiskliniken, Minden, Germany. 4. Department for Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany.
Abstract
BACKGROUND: In oral cancer the prognostic significance of clinical staging (cTNM) is regarded inferior to histopathologic staging (pTNM) after surgery. This is mainly due to the point that the quality of the cTNM strongly depends on the clinical and radiological examination techniques applied and the physician's experience. The aim of this study was to evaluate the prognostic quality of cTNM and pTNM in a single center cohort. METHODS: This retrospective study included 392 patients with treatment-naive oral squamous cell carcinoma (OSCC). All patients received primary surgery including a neck dissection. According to tumor stage and histopathologic risk factors patients received adjuvant radiotherapy (RT) or radiochemotherapy (RCT). Prognostic factors were identified in univariate analysis by using the log rank test and in multivariate analysis through Cox regression. RESULTS: Clinical and histopathologic staging showed concordance in 62% for the primary tumor and 59% for cN- and pN-classification. In 58% of the cases of discordance the primary tumor was overstaged. In case of discordance of metastatic spread to the cervical lymph nodes, lymph node involvement showed overstaging in 78%. In univariate analysis cT-, cN-, cT- and pT-classification had a significant impact (p<0.05) on overall survival (OS). In multivariate analysis only pT- and pN-classification had a significant impact on OS. CONCLUSION: Despite advances and modern radiologic techniques, pTNM has a higher prognostic quality than cTNM. Discordance between clinical and histopathologic staging was observed in up to 40%. When discordance was observed overstaging for clinical T-stage and clinical N-stage was more likely than understaging.
BACKGROUND: In oral cancer the prognostic significance of clinical staging (cTNM) is regarded inferior to histopathologic staging (pTNM) after surgery. This is mainly due to the point that the quality of the cTNM strongly depends on the clinical and radiological examination techniques applied and the physician's experience. The aim of this study was to evaluate the prognostic quality of cTNM and pTNM in a single center cohort. METHODS: This retrospective study included 392 patients with treatment-naive oral squamous cell carcinoma (OSCC). All patients received primary surgery including a neck dissection. According to tumor stage and histopathologic risk factors patients received adjuvant radiotherapy (RT) or radiochemotherapy (RCT). Prognostic factors were identified in univariate analysis by using the log rank test and in multivariate analysis through Cox regression. RESULTS: Clinical and histopathologic staging showed concordance in 62% for the primary tumor and 59% for cN- and pN-classification. In 58% of the cases of discordance the primary tumor was overstaged. In case of discordance of metastatic spread to the cervical lymph nodes, lymph node involvement showed overstaging in 78%. In univariate analysis cT-, cN-, cT- and pT-classification had a significant impact (p<0.05) on overall survival (OS). In multivariate analysis only pT- and pN-classification had a significant impact on OS. CONCLUSION: Despite advances and modern radiologic techniques, pTNM has a higher prognostic quality than cTNM. Discordance between clinical and histopathologic staging was observed in up to 40%. When discordance was observed overstaging for clinical T-stage and clinical N-stage was more likely than understaging.
Authors: Wattawan Wongpattaraworakul; Katherine N Gibson-Corley; Allen Choi; Marisa R Buchakjian; Emily A Lanzel; Anand Rajan Kd; Andrean L Simons Journal: Front Oncol Date: 2022-07-25 Impact factor: 5.738
Authors: Steffen Spoerl; Michael Gerken; Andreas Mamilos; René Fischer; Stefanie Wolf; Felix Nieberle; Christoph Klingelhöffer; Johannes K Meier; Silvia Spoerl; Tobias Ettl; Torsten E Reichert; Gerrit Spanier Journal: Clin Oral Investig Date: 2020-08-04 Impact factor: 3.573