Time between Diagnosis and Treatment of Hypopharynx and Larynx Cancer: Are Longer Delays Associated with Higher Discrepancy between Clinical and Pathological Staging?

Abstract

Introduction At the time of diagnosis, treatment strategies for cancer are largely based upon clinical staging. However, discrepancy between clinical and pathological staging has been reported. Objective To assess the rate of staging discrepancy in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma (LHSCC), the potential influence of higher interval of time from diagnosis to primary surgical treatment, and whether this has any impact on survival outcomes. Methods Retrospective study of patients with LHSCC proposed for primary surgical treatment. Results The study population included 125 Caucasian patients with LHSCC. The level of agreement between clinical and pathological tumor staging was moderate (Cohen’s Kappa: 0.400; p < 0.001) and similar result was found for node staging (Cohen’ Kappa: 0.520; p < 0.001). The mean time between diagnosis and surgical treatment was 26.66 days and no statistically significant influence was found with staging discrepancy. The sample presented a 5-year Overall Survival (OS) of 58.2% and a Disease-specific survival (DSS) of 72.6%. No statistically significant impact of staging discrepancy on survival was found. Conclusion For advanced LHSCC, based on the findings of physical examination, endoscopy and imaging, is possible to achieve a moderate accuracy between clinical and pathological staging which allows a reliable counselling and treatment planning. Interval of time under 3–4 weeks between diagnosis and surgical treatment does not influence the rate of discrepancy. However, almost 30% of staging discrepancy is expected due to false negatives of imaging and limitations of physical exams.

Comparison of Clinical and Pathological Staging in Patients with Head and Neck Cancer After Neck Dissection

“…The age at presentation and male predominance in the present study were similar to what has been previously presented. 8 9 11 13 15 On the other hand, tobacco and alcohol consumption were not as frequent as previously reported, 8 9 11 probably due to lack of information on clinical data. The clinical staging in this population was I/II in 39.3% and III/IV in 60.7%, which is more balanced when compared with previous studies with a higher inclusion of advanced disease 8 9 11 or with another study with a higher rate of initial stages of the disease.…”

“…Thus, the survival analysis may have been biased by the significant number of censored patients, even though there was a similar censored rate among all groups. Previous reports have also showed no differences in mortality or disease-free survival among groups, 9,11,14,15 which may be explained by treatment adjustments according to pathological staging, in which upstaging a patient may enable appropriate adjuvant treatment and downstaging a patient may prevent unnecessary morbidity from excessive adjuvant treatment. On the other hand, other retrospective studies have shown increased mortality on pathological T upstaging, 13 nodal upstaging, 8 or both.…”

“…Furthermore, regarding laryngeal cancer, there was an agreement in both T staging and overall staging of 61.5% and on nodal staging of 75%, which are similar to those previously reported. 11 Even though Celakovsky et al found a similar agreement on nodal staging, they found a higher agreement on T staging of 85.5%. 13 Overall staging disagreements were associated with clinical overall staging, in which cII and cIII had a disagreement in almost three quarters of the cases, with upstaging from cII to pIII and from cIII to pIVa being the most common causes of disagreement.…”

“…Furthermore, regarding laryngeal cancer, there was an agreement in both T staging and overall staging of 61.5% and on nodal staging of 75%, which are similar to those previously reported. 11 Even though Celakovsky et al found a similar agreement on nodal staging, they found a higher agreement on T staging of 85.5%. 13…”

Overview on Molecular Biomarkers for Laryngeal Cancer: Looking for New Answers to an Old Problem

“…All these findings contribute to assessing the clinical TMN (cTMN) classification. In addition, a detailed histopathological analysis performed on the tumor specimens defines the pathological TMN (pTMN) [ 7 ].…”