Pecorari Giancarlo, Lorenzi Andrea, Caria Matteo, Motatto Gian Marco, Riva Giuseppe
Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
Cancers (Basel). 2025 Jan 28;17(3):455. doi: 10.3390/cancers17030455.
: Laryngeal squamous cell carcinoma (LSCC) is one of the most prevalent and challenging malignancies of the head and neck. Clinical staging (cTNM) plays a pivotal role in therapeutic decision-making. However, current imaging modalities often fall short, resulting in discrepancies between cTNM and pathological staging (pTNM). This systematic review aimed to critically evaluate the existing literature on the concordance between clinical and pathological staging of LSCC, quantifying staging inaccuracies and highlighting the prevalence of both under- and overstaging at diagnosis. : A comprehensive search of the English-language literature was conducted across multiple databases, including PubMed, Embase, Scopus, the Cochrane Library, and Web of Science. Eligibility was limited to retrospective case series and observational studies reporting sufficient data to directly correlate individual patients' cTNM and pTNM classifications. : Thirty-one studies comprising 7939 patients met the inclusion criteria. The overall concordance rate between cT and pT was approximately 86.43%. The concordance rates between cT and pT were 82.41%, 82.03%, 78.14%, and 89.64% for cT1, cT2, cT3, and cT4, respectively. Most discordant cases in cT2 and cT3 involved understaging at clinical diagnosis. : The limited accuracy of clinical staging in reflecting the true extent of disease remains a critical challenge in the management of LSCC. The inability of current imaging techniques to reliably detect the subtle invasion of key anatomical structures contributes to both under- and overstaging, with significant clinical implications. For patients undergoing non-surgical organ-preservation strategies, these inaccuracies may adversely affect oncologic outcomes.
喉鳞状细胞癌（LSCC）是头颈部最常见且具有挑战性的恶性肿瘤之一。临床分期（cTNM）在治疗决策中起着关键作用。然而，目前的影像学检查方法常常存在不足，导致cTNM与病理分期（pTNM）之间存在差异。本系统评价旨在严格评估关于LSCC临床分期与病理分期一致性的现有文献，量化分期不准确情况，并突出诊断时分期过低和过高的发生率。：在多个数据库中对英文文献进行了全面检索，包括PubMed、Embase、Scopus、Cochrane图书馆和Web of Science。纳入标准仅限于报告有足够数据以直接关联个体患者cTNM和pTNM分类的回顾性病例系列和观察性研究。：31项研究共纳入7939例患者，符合纳入标准。cT与pT的总体一致率约为86.43%。cT1、cT2、cT3和cT4的cT与pT一致率分别为82.41%、82.03%、78.14%和89.64%。cT2和cT3中大多数不一致的病例在临床诊断时分期过低。：临床分期在反映疾病真实范围方面的准确性有限，仍然是LSCC管理中的一个关键挑战。目前的成像技术无法可靠地检测关键解剖结构的细微侵犯，导致分期过低和过高，具有重大的临床意义。对于接受非手术器官保留策略的患者，这些不准确可能会对肿瘤学结果产生不利影响。
