Patterns of Discordance Between Clinical and Pathologic Stage in Head and Neck Cancer

Area of Science:

• Oncology
• Head and Neck Surgery
• Pathology

Background:

• Accurate staging is crucial for head and neck squamous cell carcinoma (HNSCC) treatment planning and prognostication.
• Discordance between clinical and pathological staging can lead to suboptimal treatment decisions and affect data interpretation.

Purpose of the Study:

• To investigate patterns of discordance between clinical and pathological T and N staging in HNSCC across multiple anatomical sites.
• To quantify the agreement and identify specific sites with high discordance in HNSCC staging.

Main Methods:

• Retrospective analysis of 580 newly diagnosed, surgically treated HNSCC patients over a 10-year period.
• Comparison of clinical T and N staging with pathological T and N staging.
• Calculation of Cohen's kappa (κ) to assess agreement and identify discordant sites.

Main Results:

• Overall staging agreement was moderate (κ = 0.55), with 33% of cases showing discordance.
• Highly discordant sites (κ < 0.45) included T2 oral cavity, T2 oropharynx, T3 larynx, and N1 lymph nodes.
• Specific patterns observed: T2-4 oral cavity cancers often overstaged; T3 larynx cancers frequently understaged.

Conclusions:

• A quantifiable pattern of discordance exists between clinical and pathological staging in HNSCC, particularly in certain sites.
• Multidisciplinary tumor board evaluation can help identify and mitigate the impact of staging discrepancies on treatment.
• Discordant staging poses challenges for prognostication, treatment application, and data accuracy, necessitating further investigation to improve clinical staging accuracy.