title: Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making.
abstract: BACKGROUND
  Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN).
  
  
  METHODS
  The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages.
  
  
  RESULTS
  Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate of occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS.
  
  
  CONCLUSIONS
  Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria.
authors.affiliation: The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030-4009, USA. jmyers@mdanderson.org
authors.forename: Jayson S
authors.initials: JS
authors.lastname: Greenberg
authors.forename: Adel K
authors.initials: AK
authors.lastname: El Naggar
authors.forename: Vivian
authors.initials: V
authors.lastname: Mo
authors.forename: Dianna
authors.initials: D
authors.lastname: Roberts
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Myers
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D002465:Cell Movement; D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008499:Medical Records; D037981:Neck Dissection; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome