Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance.
BACKGROUND
Accurate tumor-node-metastasis(TNM) staging of oral cavity cancer(OCC) is very important in the management of this dismal disease. However, stage migration from cTNM to pTNM was found in a portion of OCC patients. The objective of this study was to determine the possible causes of discrepancy between cTNM and pTNM in OCC and the clinical impacts of stage migration.


METHODS
Clinical and pathological data of 252 OCC patients were retrospectively reviewed and compared each other. Clinical staging was determined through the multidisciplinary evaluation of pre-treatment work-ups including PET/CT. In addition, we compared the up-staged cases with those in the no-change group with the same pTNM stages to identify the clinical impacts of such change.


RESULTS
Clinical staging yielded overall 82.5% diagnostic accuracy in predicting pathological tumor status, and tumor extent was under-estimated in 9.5-13.5% of cases. The main causes of T up-staging were under-estimation of surface dimension (62.5%) and deep invasion to tongue extrinsic muscles (37.5%). N up-staging was due to occult single (57.6%) and multiple (42.4%) metastases. Surprisingly, TNM up-staging in our series did not have prognostic significance under the current management protocol.


CONCLUSIONS
Clinical under-estimation of pathological tumor extent occurred in approximately 13% of OCC, without clinical impacts on prognosis.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Nayeon
N
Choi
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Yangseop
Y
Noh
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eun Kyu
EK
Lee
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Manki
M
Chung
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Chung-Hwan
CH
Baek
Department of Molecular and Cellular Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
Kwan-Hyuck
KH
Baek
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Han-Sin
http://orcid.org/0000-0003-4652-0573
HS
Jeong
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
mouth neoplasm; neoplasm staging; prognosis; surgery; treatment outcome