口腔癌cTNM与pTNM分期的差异及其预后意义。
Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance.
作者信息
Choi Nayeon, Noh Yangseop, Lee Eun Kyu, Chung Manki, Baek Chung-Hwan, Baek Kwan-Hyuck, Jeong Han-Sin
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Molecular and Cellular Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
出版信息
J Surg Oncol. 2017 Jun;115(8):1011-1018. doi: 10.1002/jso.24606. Epub 2017 Mar 23.
INTRODUCTION
Accurate tumor-node-metastasis(TNM) staging of oral cavity cancer(OCC) is very important in the management of this dismal disease. However, stage migration from cTNM to pTNM was found in a portion of OCC patients. The objective of this study was to determine the possible causes of discrepancy between cTNM and pTNM in OCC and the clinical impacts of stage migration.
METHODS
Clinical and pathological data of 252 OCC patients were retrospectively reviewed and compared each other. Clinical staging was determined through the multidisciplinary evaluation of pre-treatment work-ups including PET/CT. In addition, we compared the up-staged cases with those in the no-change group with the same pTNM stages to identify the clinical impacts of such change.
RESULTS
Clinical staging yielded overall 82.5% diagnostic accuracy in predicting pathological tumor status, and tumor extent was under-estimated in 9.5-13.5% of cases. The main causes of T up-staging were under-estimation of surface dimension (62.5%) and deep invasion to tongue extrinsic muscles (37.5%). N up-staging was due to occult single (57.6%) and multiple (42.4%) metastases. Surprisingly, TNM up-staging in our series did not have prognostic significance under the current management protocol.
CONCLUSION
Clinical under-estimation of pathological tumor extent occurred in approximately 13% of OCC, without clinical impacts on prognosis.
引言
口腔癌（OCC）准确的肿瘤-淋巴结-转移（TNM）分期对于这种难治性疾病的治疗非常重要。然而，部分口腔癌患者存在从临床TNM（cTNM）分期到病理TNM（pTNM）分期的迁移。本研究的目的是确定口腔癌患者cTNM与pTNM分期存在差异的可能原因以及分期迁移的临床影响。
方法
回顾性分析252例口腔癌患者的临床和病理数据并进行相互比较。通过包括PET/CT在内的治疗前检查的多学科评估来确定临床分期。此外，我们将分期上调的病例与具有相同pTNM分期的未改变组病例进行比较，以确定这种改变的临床影响。
结果
临床分期在预测病理肿瘤状态方面的总体诊断准确率为82.5%，9.5%-13.5%的病例存在肿瘤范围低估的情况。T分期上调的主要原因是表面尺寸低估（62.5%）和舌外肌深层浸润（37.5%）。N分期上调是由于隐匿性单处转移（57.6%）和多处转移（42.4%）。令人惊讶的是，在当前治疗方案下，我们系列中的TNM分期上调没有预后意义。
结论
约13%的口腔癌患者存在临床对病理肿瘤范围的低估，且对预后无临床影响。
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