Author(s)
Kevin J Contrera MD MPH
Patrick T Tassone MD
Bryan B Hair BS
Chandana A Reddy MS
Brandon B Prendes MD
Affiliation(s)
Cleveland Clinic;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the accuracy of clinical laryngeal cancer staging, identify preoperative factors that could improve staging accuracy, and discuss the postoperative impact of inaccurate staging.
Objectives: Evaluate the accuracy of clinical laryngeal cancer staging. Identify preoperative factors that could improve accuracy and determine the postoperative impact of inaccurate staging.
Study Design: Retrospective chart review of 265 consecutive patients who underwent total laryngectomy (124 primary and 141 salvage) for laryngeal squamous cell carcinoma at a tertiary care hospital from 2001-2017.
Methods: Accuracy of clinical tumor (T) and nodal (N) staging was compared against pathologic staging. Multivariate regression and Cox proportional hazards were performed.
Results: Accuracy of T and N staging were 0.969 (standard error [SE]=0.010) and 0.866 (SE=0.020) respectively. 47 patients (17.7%) changed between T 1-2 and 3-4, with 15 patients upstaged and 32 patients downstaged. 78 patients (29.4%) had incorrect N staging, with 34 patients upstaged and 44 patients downstaged. Salvage patients were more likely to have inaccurate N staging (40.3% vs 19.5%, p<.001) but not T staging (19.4% vs. 16.3%, p=0.627). There was a nonsignificant trend toward greater accuracy with preoperative PET scan (OR 0.639, p=.168), but there was no association with laryngeal subsite (p=0.346) or time to treatment (p=.321). Inaccurate staging was not significantly associated with poorer outcomes, including positive margins (p=.292), need for chemotherapy (p=.261), recurrence (p=.257), or survival (p=.636).
Conclusions: This is the first study to report the accuracy of clinical laryngeal cancer staging. A majority of inaccurately staged patients are downstaged, with a small portion of patients possibly overtreated for laryngeal cancer. We describe preoperative factors associated with accurate staging and outcomes associated with inaccurate staging.