Page 45 - Revista SPORL - Vol 59. Nº2

Impact in 5-year OS of the discrepancies between micrometastasis. Nevertheless, the gold standard for
cTNM and pTNM diagnosis micrometastasis and ENE is still histological
Using the Kaplan-Meier method to create survival analysis.
curves, and Log Rank to compare them, the estimated Regarding 5-year OS, we did not find any difference
5-year OS was not significantly different for patients in survival curves between patients who had been
who had been upstaged in cT and cN (Log Rank = 0,254, upstaged. This information is contradictory in the
p = 0,614, and Log-Rank = 0,26, p = 0,871, respectively). literature. Celakovsky et al (2017) found that discordance
between cTNM and pTNM was a prognostic factor, and
DISCUSSION should indicate the need for post-operative treatment
Given the importance of cTNM in the clinical decision, (if not indicated by pTNM itself). 2
this process must be as meticulous as possible. It has Our study has some limitations that can directly
a direct impact on treatment planning and prognosis impact results: because it is based on a retrospective
establishment. analysis, it took into account physical exams performed
Our rate of discrepancy in cT (44.7%) was higher than by different Surgeons, imaging studies reported by
described in the literature. 3,4,8 Despite imaging studies different Radiologists, and histopathological analysis ARTIGO ORIGINAL ORIGINAL ARTICLE
contributing to larynx tumors staging process after by different Pathologists; moreover, it has a limited
clinical examination, there are some relatively common number of patients.
discordance motives, such as cartilage invasion, which,
in our population, was the most common factor for CONCLUSION
discordance, leading both to upstaging and downstaging Despite advances in clinical evaluation and imaging
tumors. As stated before, despite some controversy studies, discrepancies between cTNM and pTNM are
in their sensitivity, MRI has shown greater potential still frequent, and, in our population, they reached
than CT in detecting cartilage invasion, above all in low 44.7% in cT and 29.8% in cN. The most frequent reason
stages of larynx cancer. Nevertheless, their specificity is for this difference was the invasion of the outer cortex of
9
compromised by some potential artifacts related to the the thyroid cartilage not diagnosed in the preoperative
inflammatory tumor-related changes in cartilage, which evaluation. Despite that, according to our research,
can be easily mistaken with invasion. More recent there is no difference in 5-year OS between patients
technology, such as dual-energy CT, is being investigated with and without discrepancies in TNM staging, the
to surpass mostly the specificity problems of CT and impact of the staging itself is well known, so improving
MRI, to improve staging and prognosis establishment. 9 diagnostic accuracy should be a priority among Head
Regarding cT discrepancies, we verified an association and Neck cancer dedicated surgeons and oncologists.
between discrepancies in cT and glottic tumors, which Conflito de Interesses
is compatible with the literature. Literature relates Os autores declaram que não têm qualquer conflito de
2
the frequent discrepancies in glottic tumors staging interesse relativo a este artigo.
predominantly with the ones involving the anterior
commissure; nevertheless, authors report a higher rate Confidencialidade dos dados
of upstaging (as high as 50% of the cases) in this tumors, Os autores declaram que seguiram os protocolos do seu
which is the opposite of our results, in which we found a trabalho na publicação dos dados de pacientes.
high rate of downstaging. 10
Another factor that might influence the rate of upstaging Proteção de pessoas e animais
is the delay in the treatment after the first diagnosis. We Os autores declaram que os procedimentos seguidos
found a statistically significant difference between the estão de acordo com os regulamentos estabelecidos
median time between diagnosis and surgery. Despite pelos diretores da Comissão para Investigação Clínica e
our median time to treatment (27 days) being similar to Ética e de acordo com a Declaração de Helsínquia da
the one presented by other authors, they did not find Associação Médica Mundial.
any significant difference between patients who had
discrepancies between cTNM and pTNM. 4 Política de privacidade, consentimento informado e
On the other hand, the discrepancy in cN (29.8%) Autorização do Comité de Ética
was similar to other oncology groups. Most authors Os autores declaram que têm o consentimento por
2,4
relate the discrepancies in the neck evaluation with escrito para o uso de fotografias dos pacientes neste
micrometastasis and extranodular extension (ENE). Neck artigo.
palpation alone may fail to identify micrometastasis
besides lacking the capability of adequate dimension Financiamento
measurement. CT scan is, undoubtfully, very Este trabalho não recebeu qualquer contribuição,
4,6
important in these patients’ evaluation and may financiamento ou bolsa de estudos.
improve diagnostic accuracy, despite low sensitivity to

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