Comparison of Clinical and Pathological T Staging in Gingivobuccal Complex Cancers-A Retrospective Analysis

Accurate staging of gingivobuccal complex (GBC) cancers is critical for treatment planning and prognosis. Discrepancies between clinical T staging (cT) and pathological T staging (pT) may lead to over or undertreatment. This study examines these discrepancies to highlight their implications. A retrospective observational study of 469 patients with GBC cancers was conducted at a tertiary care center. Patients underwent clinical staging based on imaging and physical examination and pathological staging following surgical resection. The agreement between cT and pT stages was analyzed using Cohen's kappa coefficient. Concordance between cT and pT stages was 32.08%. Upstaging (pT > cT) occurred in 13.4% of cases, primarily due to extra nodal extension or nodal metastases, while 51.4% of cases were downstaged, often from cT4b to pT4a. Discrepancies arose from misjudgements of tumor size, depth of invasion, and involvement of structures like the masticator space, infratemporal fossa, and bone. Significant discrepancies between cT and pT staging in GBC cancers underscore the limitations of preoperative assessments. Integrating advanced imaging and tagging structures intraoperatively could improve staging accuracy, optimize treatment decisions, and enhance outcomes.