Pinto João Viana, Sousa Mafalda Martins, Silveira Helena, Vales Fernando, Moura Carla Pinto
Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal.
Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal.
Int Arch Otorhinolaryngol. 2023 Sep 14;27(4):e571-e578. doi: 10.1055/s-0042-1758208. eCollection 2023 Oct.
Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging ( = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality ( = 0.016), clinical T staging ( = 0.049), and histology ( = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age ( = 0.013), clinical N staging ( < 0.001), and presence of extranodal invasion ( < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.
临床和病理分期对头颈癌（HNC）患者的预后起着重要作用。本研究旨在比较HNC患者的临床和病理T、N分期及总体分期，确定与这些差异相关的因素，并分析和比较分期不一致时的生存率或无病生存率。回顾性队列研究纳入了2010年1月至2020年12月在一家三级医院中心耳鼻喉科接受颈部清扫术的每一位患者。共分析了79例患者；他们的平均年龄为58.52±13.15岁，88.9%为男性。评估总体分期时，发现53%存在差异（36.4%分期上调，16.6%分期下调），且与临床总体分期显著相关（P = 0.006）。关于T分期，45.5%存在差异（30.3%分期上调，15.2%分期下调），且与影像学检查方式（P = 0.016）、临床T分期（P = 0.049）和组织学（P = 0.017）显著相关。N分期差异为38%（25.3%分期上调，12.7%分期下调），且与年龄（P = 0.013）、临床N分期（P < 0.001）和结外侵犯的存在（P < 0.001）显著相关。在总体、T和N分期中，上述差异均与较高的死亡率或较高的疾病复发无关。总体而言，在相当数量的病例中，T和N分期以及总体分期存在差异，总体分期差异在高达53%的病例中出现。这些差异似乎并不影响总生存率和无病生存率。
