title: The impact of computed tomography on pretherapeutic staging in patients with laryngeal cancer: demonstration of the Will Rogers' phenomenon.
abstract: BACKGROUND
  The purpose of this study was to demonstrate that pretherapeutic CT of patients with primary laryngeal cancer results in stage migration, therefore affecting laryngeal cancer outcome data.
  
  
  METHODS
  We retrospectively reviewed the medical records of 90 patients with primary laryngeal cancer diagnosed between January 1, 1995, and December 31, 1997, at a university hospital.
  
  
  RESULTS
  The disease in 15 (17%) of 90 patients was reclassified into a new TNM stage after pretherapeutic CT. As a result, stage-specific survival rates improved in three of four TNM stages, even though average survival for the entire cohort did not change.
  
  
  CONCLUSIONS
  The TNM staging system is not a temporally stable classification and prediction system, because TNM assignment varies on the basis of the type of pretherapeutic evaluation. Outcome data for patients with laryngeal cancer must account for the introduction of new technologies that affect our ability to diagnose and stage this disease.
authors.affiliation: Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8115, St. Louis, MO 63110, USA.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Champion
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010808:Physical Examination; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed