Page 56 - Portuguese Journal - SPORL - Vol 61. Nº2

shift in the treatment of this type of tumors, between the clinical and pathological staging
focusing not only on survival but also on the
functional outcomes and quality of life. Thus,
the number of patients undergoing organ-
preserving treatments has increased. In
4
these patients, because there is no surgical
specimen, staging is solely clinical and
based on the clinical and imaging findings.
1
Currently, there is no diagnostic method that
evaluates with total precision the extension
of the primary tumor or presence of regional
metastases, which can lead to discordance
between the clinical and pathological staging.
5
Although the anatomic preservation of
the larynx does not equal its functioning,
clinical overstaging is typically associated
with worse functional outcomes (because of
the loss of voice and presence of a definitive
tracheostoma) , whereas understaging is
6
associated with an increase in the recurrence
and mortality rates. 1
The objective of the present study was to
evaluate the accuracy of clinical staging of the
cancer of the larynx and hypopharynx, as well
as its impact on the choice of treatment and
associated factors.
Material and Methods
This retrospective cohort study evaluated
patients who underwent total laryngectomy in
the Department of Otorhinolaryngology of the
Centro Hospitalar Vila Nova de Gaia/Espinho
between January 1, 2013 and December 31,
2021. Only patients who had the histological
subtype of squamous cell carcinoma were
selected. Staging of cancer of the larynx and
hypopharynx was based on the 8 edition of
th
the TNM classification.
The medical records were reviewed and the
following clinical variables were analyzed
and grouped: a) demographic – age and
sex, location of the primary tumor, adjuvant
treatment, relapse, and death; b) clinical
staging based on the combination of clinical
and imaging findings; c) pathological staging
and margins of the surgical specimen (analyzed
by different pathologists of the Anatomic
Pathology department); and d) difference
198 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
for the subcategories of T and N.
Differences between the categories of T
and N and the final overall staging were
only considered when there was a change
in the category (but not in the subcategory).
Downstaging occurred in cases in which the
pathological stage was lower than the clinical
stage, while upstaging occurred in cases in
which the pathological stage was higher than
the clinical stage.
Data analysis was performed using the SPSS ®
software, version 27 .0. Discrete variables were
expressed as frequencies and percentages
and continuous variables as means and
standard deviations (SD) in the case of
normally distributed data, and medians and
interquartile ranges in the case of a non-
normal distribution. The chi-square test or
Fisher’s exact test were used to compare the
categorical variables between the groups.
Statistical significance was set at p<0.05.
Results
The median prevalence of total laryngectomy
over the study period was five cases per year ,
with a peak in 2019 (Figure 1).
Over the study period, 54 patients underwent
total laryngectomy along with bilateral neck
lymph node dissection, of which 52 were
men (96.3%) and two were women (3.7%);
the age range was 40-87 years (mean age ±
standard deviation [SD] 61.04±9.40 years). The
primary tumor was supraglottic, glottic, and
hypopharyngeal in 59.3%, 24.1%, and 16.6%
of the cases, respectively. Positron emission
tomography-computed tomography (PET-CT)
was performed in approximately half of the
cases (53.7%), and N positive (N+) clinical stage
was more frequent among patients who
underwent this examination. The patients
were divided into four categories according to
the overall staging (pathological): 66% of the
patients were in stage IV, 24.1% were in stage
III, 5.6% were in stage II, and 4.3% were in stage
I. The margins of the surgical specimen were <
5 mm in eight cases. Adjuvant treatment with
radiotherapy (RT) was necessary in 38 cases