Page 43 - Revista SPORL - Vol 59. Nº2

metastasis in clinical and pathological staging were TABLE 1
considered cN- and pN-, respectively; on the other Descriptive features
hand, patients with neck metastasis in clinical and
pathological staging were considered cN+ and pN+, Result
respectively. American Joint Committee on Cancer Age (Mean ± SD) 59.8 ± 9.6
8th edition (2017) was used to evaluate and stage the Minimum 42
patients in the time frame evaluated. 1 Maximum 79
Gender
Statistical analysis Female 4,3% (n=2)
Continuous variables with normal distribution were Male 95,7% (n=45)
described as mean ± standard deviation. Continuous Location
variables without normal distribution were described as Supraglottic 44,7% (n=21)
median and interquartile range (IQR). Non-parametric Glottic 17% (n=8)
Mann-Whitney U test was used to compare medians of Transglottic 38,3% (n=18)
continuous variables without normal distribution. The Days between histopathological diagnosis 27 (18) ARTIGO ORIGINAL ORIGINAL ARTICLE
Pearson Chi-square was used to evaluate the correlation and surgical treatment [Median (IQR)]
between two categorical variables. Cohen kappa Minimum 4
coefficient was used to assess the accuracy between Maximum 75
cTNM and pTNM. Staging cTNM
Kaplan-Meier method was used to create survival Stage II 17% (n=8)
curves, and Log Rank was used to compare between Stage III 19,1% (n=9)
them. Stage IVa 61,7% (n=29)
SPSS 24.0 for macOS was used for the statistical analysis. Stage IVb 2,1% (n=1)
A p-value < 0.05 was used to reject the null hypothesis. Staging pTNM
Stage I 4,3% (n=2)
RESULTS Stage II 8,5% (n=4)
Of the 77 patients who underwent PL or TL in the Stage III 19,1% (n=9)
designated time frame, 47 fulfilled the inclusion Stage IVa 63,8% (n=30
criteria. 21 were excluded given neck dissection was Stage IVb 4,3% (n=2)
not performed; 4 patients underwent surgery as salvage
treatment; 5 patients were lost to follow-up (emigrants in 29,8% of the patients (n=14). The level of agreement
who returned to their living country after surgery). between cT and pT was fair (Cohen Kappa = 0,310, p
The analyzed population was comprised of a majority = 0,01); on the other hand, there was a substantial
of male patients (95,7%, n=45), with a mean age of 59.8 agreement between cN and pN (Cohen Kappa = 0,688,
±9.6 year-old (range 42-79). p < 0,001).
Regarding location, the most common were the The highest rate of discrepancy regarding cT was
supraglottic tumors (44,7%, n=21), followed by the verified in the patients with a tumor staged as cT2,
transglottic (38,3%, n=18), and glottic (17%, n=8). with an upstaging rate of 40% and downstaging of 20%,
The median time between the first histopathological followed by cT3, with an upstaging rate of 37% and
confirmation and definitive surgical treatment was 27 downstaging of 11%. The most common reasons for up
days (IQR=18). The surgical approach varied between and downstaging were the invasion of the outer cortex
PL, in 17% (n=8), and TL in 83% (n=39), always associated of the thyroid cartilage not visible in preoperative
with neck dissection. imaging studies and an apparent vocal cord fixation in
Most of the patients had advanced stages in the pre- physical examination, respectively (table 4).
operative period, with stage IVa in 61,7% of the patients Regarding cN (Table 2), there was a discrepancy in all
(n=29), followed by stage III (19,1%, n=9). Most of the the cN+ necks staged as cN2a and cN3b. On the other
patients were cN+ (59,6%, n=28). The pathological hand, the cN- necks were the ones with the highest
staging was advanced for the majority of cases, with IVa correspondence between cN and pathological staging.
in 63,8%, and stage III in 19,1%. Of the analyzed factors, there were only two that were
Regarding follow-up, there was a 5-year OS of 70,2% associated with a cTNM change after pathological
(n=33). Relapse was diagnosed in 17,8% of patients, in a analysis: regarding location, the glottic tumors were
mean time of 473,4 ± 267,2 days. associated with a higher rate of discrepancy (p = 0,020);
on the other hand, there was a higher median time gap
Discrepancies between cTNM and pTNM between diagnosis and surgery in patients who had
We verified a discrepancy between cTNM and pTNM been upstaged (p = 0,048).
in 66% (n=31) of the cases: a different T (Table 2) was
verified in 44,7% of the patients (n=21) and a different N

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