Discordance between clinical and pathological TNM classification: influence on results of treatment and prognosis in patients with laryngeal cancer

Čelakovský, Petr; Kalfeřt, David; Smatanová, Katarína; Kordač, Petr; Laco, Ján; Chrobok, Viktor

doi:10.4149/neo_2017_219

Cited by 13 publications

(30 citation statements)

References 18 publications

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“…Furthermore, they could show that a disparity in N-stage was more frequent in supraglottic laryngeal cancer patients and an overestimated lymph node status, but without influence on the OS or DFS, whereas a disparity in T-stage was more frequent in glottic cancer patients with impact significantly decreasing OS and DFS. Furthermore, results for detected positive lymph node metastases in HNSCC cN0 patients vary from 2 up to 58% in the previous literature [9,10,15,18,25]. This leads to the conclusion that the detection of occult lymph node metastases is dependent on the histopathological detection method, the pathologist and surely also the surgical profoundness.…”

Section: Impact and Importance Of Nodal Status And Elective Neck Dissmentioning

confidence: 96%

“…Nevertheless, 63 cN + patients (43.7%) included in this study who underwent ND did not have lymph node metastases and were clinically over-staged. Celakovsky et al [9] described a discordance of clinical and pathological TNM staging in 32% of 124 included laryngeal cancer patients. They described the nodal status as one of the significant negative influences on OS and DFS.…”

Section: Impact and Importance Of Nodal Status And Elective Neck Dissmentioning

confidence: 99%

“…Although preoperative staging methods like ultrasound, CT and MRI have become more and more precise and effective, microscopic examination following ND still remains the gold standard for the detection of lymph node metastases. Nevertheless, if only micrometastases are present in the dissected lymph node, typically localized in the subcapsular sinuses of lymph nodes, pathologists can miss the tumor positivity [8,9,14]. Further studies should include this, e.g.…”

Section: Impact and Importance Of The Lnrmentioning

confidence: 99%

“…by double checking the LNR in the histopathologic samples. Nevertheless, previous studies described up to 30% of false-negative cases in preoperative clinical cN0 staged patients, due to still-lacking accuracy in staging and imaging techniques [2,4,9].…”

Section: Impact and Importance Of The Lnrmentioning

confidence: 99%

“…Oztürkcan et al [28] described a higher risk for contralateral metastases in patients with ipsilateral lymph node invasion with and without extracapsular spread. Furthermore, different authors described the significant reduction of overall survival (OS) in patients with positive lymph nodes [7,9]. The advantage of ND compared to neck irradiation is the subsequent histopathological examination of occult metastasis to initiate adjuvant therapy [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Surgical nodal management in hypopharyngeal and laryngeal cancer

Ketterer

Moraga

Beitinger

et al. 2020

Eur Arch Otorhinolaryngol

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Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients. Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS). Results A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant overstaging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS. Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS. KeywordsHypopharyngeal carcinoma · Laryngeal carcinoma · Overall survival · cN0 · Elective neck dissection · Head and neck cancer Abbreviations CT Computed tomography DFS Disease-free survival DM Distant metastasis HNSCC Head and neck squamous cell carcinoma LNR Lymph node ratio MRI

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Section: Impact and Importance Of Nodal Status And Elective Neck Dissmentioning

confidence: 96%

Section: Impact and Importance Of Nodal Status And Elective Neck Dissmentioning

confidence: 99%

Section: Impact and Importance Of The Lnrmentioning

confidence: 99%

Section: Impact and Importance Of The Lnrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Surgical nodal management in hypopharyngeal and laryngeal cancer

Ketterer

Moraga

Beitinger

et al. 2020

Eur Arch Otorhinolaryngol

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The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study

et al. 2022

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Background To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow‐up. Methods It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL‐PORT); the second group referred to clinical and radiological follow‐up (TL). Results PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. Conclusions A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI.

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Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

et al. 2020

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Objectives/Hypothesis Evaluate the impact and accuracy of clinical laryngeal cancer staging. Study Design Retrospective cohort study. Methods Two hundred sixty‐five consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2001 to 2017 were studied. Clinical versus pathologic tumor (T) and nodal (N) categories were compared. Logistic regression and Cox proportional hazards analyzed the association of stage change with perioperative factors and outcomes. Results Forty‐seven patients (17.7%, accuracy = 0.969 ± 0.010 [standard error]) changed between T1‐2 and T3‐4. Sixty‐four patients (24.1%, accuracy = 0.866 ± 0.020) had inaccurate N category. Salvage patients were less likely to have stage change (downstage: odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.08‐0.50, P < .001; upstage: OR = 0.41, 95% CI: 0.23‐0.74, P = .003), but more likely to have inaccurate nodal category (39.8% vs. 11.7%, P < .001). Patients with stage change tended to have greater odds of positive/close margins (upstage: OR = 1.78, 95% CI: 0.91‐3.5, P = .092) and chemotherapy (downstage: OR = 2.21, 95% CI: 0.80‐6.14, P = .128; upstage: OR = 1.87, 95% CI: 0.85‐4.11, P = .119). Stage change was associated with recurrence (P = .047) with downstaged patients less likely to recur (hazard ratio = 0.26, 95% CI: 0.08‐0.82, P = .021). Stage change was not associated with positron emission tomography scan, subsite, time to surgery, or mortality. Conclusions A third of laryngeal cancer patients were downstaged or upstaged after laryngectomy with 18% and 24% of clinical T and N categories inaccurate, respectively. Stage change was less common for salvage patients and associated with risk of recurrence. Level of Evidence 3 Laryngoscope, 131:559–565, 2021

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Discordance between clinical and pathological TNM classification: influence on results of treatment and prognosis in patients with laryngeal cancer

Cited by 13 publications

References 18 publications

Surgical nodal management in hypopharyngeal and laryngeal cancer

Surgical nodal management in hypopharyngeal and laryngeal cancer

The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

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