Value of clinical staging in patients with oral cavity carcinoma and oropharyngeal carcinoma

Introduction Interdisciplinary treatment recommendations for head and neck cancer patients are mainly based on clinical staging according to the TNM classification. This study investigates the value of clinical staging in oral cavity (OC) and oropharyngeal (OPh) carcinomas by comparing clinical and pathological stages.

Material & Methods Retrospective analysis of patients with OC and OPh carcinomas treated at the Head and Neck Tumor Center Freiburg between 2010 and 2016. Comparison between clinical/pre-therapeutic and pathological T- and N-classification (UICC classification version 7).

Results 244 patients with documented cTN and pTN stages were analyzed (oral cavity n=159, oropharynx n=85). In 155 cases, the presence of computed tomography was documented. For OC carcinomas, T stages matched in 56%, higher pT stage was present in 11%, lower in 33%. For OPh carcinomas, the agreement was 49%, a higher pT stage was present in 9% and a lower one in 41%. Regarding the N-status, there were differences depending on the primarius: In OC carcinomas, the agreement was 62%, a higher pN in 8% and a lower pN in 30%. For OPh carcinomas, the concordance was 41%, a higher pN was 6%, and a lower pN was 53%.

Conclusion For both OC and OPh carcinomas, cT stages matched pT stages in only about half of the cases; for N status, downstaging predominated in OPh carcinomas. This study shows that clinical TN stages usually overestimate tumors and therefore downstaging should be performed in case of doubt. For the assessment of N-status, the existing criteria for suspected malignancy need to be specified more precisely.

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Artikel online veröffentlicht:
24. Mai 2022