Discordance between Clinical and Pathological TNM Classifications in Patients with Oropharyngeal Cancer – Influence on Treatment and Prognosis
Authors:
P. Kordač 1; D. Kalfeřt 1,2; K. Smatanová 1; J. Laco 3; M. Vošmik 4; P. Čelakovský 1; Viktor Chrobok 1
Authors‘ workplace:
Klinika otorinolaryngologie a chirurgie hlavy a krku LF UK a FN Hradec Králové
1; ORL, foniatrie, sluchová protetika s. r. o., Plzeň
2; Fingerlandův ústav patologie, LF UK a FN Hradec Králové
3; Klinika onkologie a radioterapie LF UK a FN Hradec Králové
4
Published in:
Klin Onkol 2016; 29(2): 122-126
Category:
Original Articles
doi:
https://doi.org/10.14735/amko2016122
Overview
Background:
The aim of this study was to determine the percentage of discordance between clinical (c) and pathological (p) TNM classifications in cases of oropharyngeal carcinoma and whether it influences recurrence rate and prognosis of primary disease.
Materials and Methods:
Fifty-one patients with oropharyngeal carcinoma who underwent primary surgical treatment were included in this retrospective study. Clinical TNM was determined on the basis of clinical examinations and imaging (US, CT, or MRI), and pathological TNM was determined by a histopathologist (analysis of the primary tumor and neck lymph nodes). Concordance and discordance were statistically evaluated. As potential prognostic factors, we statistically analyzed tumor recurrence, specific and nonspecific patient survival, patient age, extent of primary tumor, lymph node positivity, number of removed lymph nodes, and positive tumor margins.
Results:
Discordance in the TNM classification was found in 27 cases. Disease-free survival was shorter in patients with discordance in T, and this was statistically significant (p = 0.034). Six patients died due to primary disease (11.8%). Disease-specific survival was at the limit of statistical significance (p = 0.069).
Conclusions:
Discordance between clinical and pathological TNM classifications was 52.9% patients with oropharyngeal carcinoma. Discordance in T is a potential prognostic factor. Improvement in cancer treatment to some extent relies on preoperative staging and should influence the decision about whether or not to administer adjuvant oncological treatment.
Key words:
TNM staging – clinical TNM classification – pathological TNM classification – oropharynx cancer – prognosis
This study was supported by project of the Czech Ministry of Health project conceptual development research organization No. 00179906 and grant PRVOUK P37/11.
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
Submitted:
18. 9. 2015
Accepted:
1. 11. 2015
Sources
1. Sobin LH, Wittekind CH (eds). TNM klasifikace zhoubných novotvarů. 5. vyd. 1997, česká verze 2000. Praha: Ústav zdravotnických informací a statistiky České republiky 2000.
2. Sobin LH, Wittekind CH (eds). TNM klasifikace zhoubných novotvarů. 6. vyd. 2000, česká verze 2004. Praha: Ústav zdravotnických informací a statistiky České republiky 2004.
3. Sobin LH, Gospodarowicz MK, Wittekind CH (eds). TNM klasifikace zhoubných novotvarů. 7. vyd. 2009, česká verze 2011. Praha: Ústav zdravotnických informací a statistiky České republiky 2011.
4. Harréus U. Surgical errors and risks – the head and neck cancer patient. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12: Doc04. doi: 10.3205/cto000096.
5. Zbären P, Becker M, Läng H. Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathology. Cancer 1996; 77(7): 1263– 1273.
6. Zbären P, Becker M, Läng H. Staging of laryngeal cancer: endoscopy, computed tomography and magnetic resonance versus histopathology. Eur Arch Otorhinolaryngol 1997; 254 (Suppl 1): S117– S122.
7. Kim JW, Yoon SY, Park IS et al. Correlation between radiological images and pathological results in supraglottic cancer. J Laryngol Otol 2008; 122(11): 1224– 1229. doi: 10.1017/S0022215108001746.
8. Kuno H, Onaya H, Fujii S et al. Primary staging of laryngeal and hypopharyngeal cancer: CT, MR imaging and dual-energy CT. Eur J Radiol 2014; 83(1): e23– e35. doi: 10.1016/j.ejrad.2013.10.022.
9. Lim JY, Park IS, Park SW et al. Potential pitfalls and therapeutic implications of pretherapeutic radiologic staging in glottic cancers. Acta Otolaryngol 2011; 131(8): 869– 875. doi: 10.3109/00016489.2011.562538.
10. Foucher M, Barnoud R, Buiret G et al. Pre- and posttherapeutic staging of laryngeal carcinoma involving anterior commissure: review of 127 cases. ISRN Otolaryngol 2012; 2012: 363148. doi: 10.5402/2012/ 363148.
11. Daisne JF, Duprez T, Weynand B et al. Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen. Radiology 2004; 233(1): 93– 100.
12. Ashraf M, Biswas J, Jha J et al. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup. Int J Clin Oncol 2011; 16(6): 686– 693. doi: 10.1007/s10147-011-0250-2.
13. De Waal PJ, Fagan JJ, Isaacs S. Pre- and intra-operative staging of the neck in a developing world practice. J Laryngol Otol 2003; 117(12): 976– 978.
14. Ferlito A, Shaha AR, Rinaldo A. The incidence of lymph node micrometastases in patients pathologically staged N0 in cancer of oral cavity and oropharynx. Oral Oncol 2002; 38(1): 3– 5.
15. Hamakawa H, Fukuzumi M, Bao Y et al. Keratin mRNA for detecting micrometastasis in cervical lymph nodes of oral cancer. Cancer Lett 2000; 160(1): 115– 123.
16. Mnejja M, Hammami B, Bougacha L et al. Occult lymph node metastasis in laryngeal squamous cell carcinoma: therapeutic and prognostic impact. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127(5): 173– 176. doi: 10.1016/j.anorl.2010.07.011.
17. Rhee D, Wenig BM, Smith RV. The significance of immunohistochemically demonstrated nodal micrometastases in patients with squamous cell carcinoma of the head and neck. Laryngoscope 2002; 112(11): 1970– 1974.
18. Koch WM, Ridge JA, Forastiere A et al. Comparison of clinical and pathological staging in head and neck squamous cell carcinoma: results from Intergroup Study ECOG 4393/ RTOG 9614. Arch Otolaryngol Head Neck Surg 2009; 135(9): 851– 858. doi: 10.1001/archoto.2009.123.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2016 Issue 2
Most read in this issue
- Extravasation of Cytostatic Drugs – Prevention and Best Practices
- Anticancer Effect of Fish Oil – a Fable or the Truth?
- Enzalutamide and Abiraterone in the Treatment of Metastatic Castration-resistant Prostate Cancer after Chemotherapy
- The Role of BRAF/MEK Inhibition in Metastatic Malignant Melanoma – a Case Study