Predictors of Clinicopathologic Stage Discrepancy in Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study

Abstract

Objective To determine the frequency, associated factors, and prognosis of clinicopathologic stage discrepancy in oropharyngeal squamous cell carcinoma (OPSCC). Study Design Retrospective study using a national database. Setting National Cancer Database. Subjects and Methods Cases of OPSCC diagnosed between January 1, 2004, and December 31, 2013, with full clinical and pathologic staging information available were identified. Demographic, clinicopathologic, and treatment variables associated with overall stage discrepancy were identified by multivariate logistic regression analysis. Results In total, 7731 cases of OPSCC were identified. Overall stage discrepancy was present in 30.2% of cases (21.9% upstaging, 8.2% downstaging). A total of 13.1% of cases were T-upstaged, and 10.5% of cases were T-downstaged; 22.9% of cases were N-upstaged, and 8.6% of cases were N-downstaged. Upstaging by overall stage was associated with a high Charlson-Deyo score, high tumor grade, number of lymph nodes examined, and increasing tumor size. No factors were positively associated with downstaging. High tumor grade was negatively associated with downstaging. For stage II, III, and IVA tumors, upstaging was associated with poorer OS. Conclusion Clinicopathologic stage discrepancy is common in OPSCC and is likely attributable to insensitive clinical staging techniques as well as to intrinsic tumor biologic properties. Upstaging is associated with poorer prognosis, which is likely due to advancement of disease.

Predicting Adverse Histopathology and Need for Postsurgical Adjuvant Therapy for Human Papilloma Virus–Associated Oropharynx Carcinoma

“…As with prior studies of non‐HPV OPSCC, this study of HPV+ OPSCC found upstaging to be more common than downstaging following primary surgery. Previous studies of non‐HPV OPSCC reported nodal upstaging rates of 21% to 23%, which aligns with our finding of 24% in the NCDB 10 , 11 . One study reporting its institution‐specific clinical and pathologic staging of HPV+ OPSCC found similar upstaging rates of 25% and downstaging of 14% based on the AJCC, seventh edition 20 .…”

“…Previous studies of non-HPV OPSCC reported nodal upstaging rates of 21% to 23%, which aligns with our finding of 24% in the NCDB. 10,11 One study reporting its institution-specific clinical and pathologic staging of HPV1 OPSCC found similar upstaging rates of 25% and downstaging of 14% based on the AJCC, seventh edition. 20 The imperfect sensitivity of head and neck examination and imaging studies such as ultrasound, computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT likely contributes to this discrepancy in clinicopathologic stages.…”

“…[6][7][8] Studies have demonstrated clinical and pathologic staging discrepancies to be common in head and neck cancers. [9][10][11][12] These studies, however, have not focused on HPV1 OPSCC. Definitive surgery and histopathologic evaluations of occult cervical nodal disease, lymph node size, pENE, PNI, and margin status can alter the preoperative expectations for adjuvant therapy based on preoperative clinical assessments.…”

“…Currently, however, clinical (presurgical) staging with physical examination and imaging has limitations 6–8 . Studies have demonstrated clinical and pathologic staging discrepancies to be common in head and neck cancers 9–12 . These studies, however, have not focused on HPV+ OPSCC.…”

Macrophages expressing TREM-1 are involved in the progression of HPV16-related oropharyngeal squamous cell carcinoma

“…TREM-1 and CD68 infiltration are also reciprocally correlated, however, none of the two markers is significantly associated to CD4 and CD8 infiltration. These points may configure a gap and deserve a comment: in a retrospective study on a database of 7731 cases, a high frequency (30.2%) of clinic-pathological stage discrepancy has been demonstrated in OP-SCCs [35]; in another study on 319 cases, long-term survivals in patients with advanced-stage have been also reported [36]. An interpretation of these events may be that the biological interference of HPV has influenced the relationships between tumour cells and its background: for these reasons, the pathological staging of OP-SCCs has been subjected to a radical revision in view of the last TNM edition [37], where HPV-related and non-related tumours have been separated.…”