To evaluate disparity between clinical and pathological tumor-node-metastasis staging in oral cavity squamous cell carcinoma patients and its impact on overall survival: An institutional study

Correlation of Clinical and Pathological TNM Staging With Histopathological Grading in Oral Squamous Cell Carcinoma

Background Oral squamous cell carcinoma (OSCC) is the most common type of head-neck cancer. The staging and grading of OSCC play an important role in disease management. Accurate staging helps in patient counseling, treatment planning, and prognostication in head-neck SCC. However, discrepancies between pathological and clinical staging have been stated, which affect disease prognosis. Method A retrospective review of 60 surgically treated patients with OSCC was done. Tumor-nodal-metastasis staging, both clinically and pathologically, was equated and tabulated to determine upstaging, downstaging, and cases where no stage change occurred. Additionally, the clinical and pathological TNM (tumor, node, metastasis) staging were correlated with the evaluation of histopathological grading. Results This study comprised 60 surgically operated OSCC patients. The T and N stages showed significant differences when compared clinically and pathologically. There was no significant correlation between histopathological grading and the disparities in TNM staging. Conclusion Some discrepancies exist between TNM staging evaluated clinically and pathologically for OSCC, which may show its effect on treatment planning and the prognosis of affected individuals. The histopathological analysis is the gold standard for the categorization of staging and grading in OSCC for proper treatment planning.

Assessment of Shame and Stigma in Head and Neck Cancer: A Meta-Analysis

Background

Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life.

Objectives

Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer.

Methods

In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed.

Results

Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched.

Conclusion

Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.

Comparison of Clinical and Pathological Staging in Patients with Head and Neck Cancer After Neck Dissection

Introduction  Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective  The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods  Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results  A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging ( p  = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality ( p  = 0.016), clinical T staging ( p  = 0.049), and histology ( p  = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age ( p  = 0.013), clinical N staging ( p  < 0.001), and presence of extranodal invasion ( p  < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion  Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.

Comparison Between Clinical and Pathological Staging After Elective Neck Dissection in Head and Neck Cancer

INTRODUCTION

Head and neck squamous cell carcinomas (HNSCC) are the most common malignancies in the head and neck. Previous studies have shown discrepancies in clinical and pathological staging, with a significant number of head and neck cancer patients who were not correctly staged. This has important implications regarding the treatment and prognosis of these patients. The aim of this study was to analyze potential disagreements in clinical and pathological staging in patients with head and neck cancer who underwent elective neck dissection.

METHODS

A retrospective study of patients with squamous cell carcinoma of the head and neck, who underwent elective neck dissection, between January 2018 and December 2020.

RESULTS

We analyzed 87 patients, with an average age of 64 ± 10.05 years, of whom 96.6% were male. The primary tumor location was the glottis (31%), oropharynx (26.4%), hypopharynx (19.5%), supraglottis (11.5%), and oral cavity (11.5%). In 87.3% there was a history of smoking and/or drinking. Pathological N (pN) staging was higher than clinical staging in 34.3% of patients (N1 in 22.9%; N2 in 8%; N3 in 3.4%). There were no significant differences between the number of nodes removed and the pN staging. However, there was a significant survival difference in patients with>15 nodes removed (p=0.05). There was also a significant difference in patients with pN up-staging regarding survival (p=0.005). Pathological T staging was different from clinical T staging (p<0.05), with an up-staging in 18.4% of the patients and a down-staging in 14.9%, without significant differences regarding survival or recurrence (p>0.05). Adjuvant treatment with radiotherapy was performed in 41.4% and with chemo-radiotherapy in 13.8% of the patients. Locoregional recurrence occurred in 17.5%.

CONCLUSION

This study revealed that clinical and pathological N staging after elective neck dissection disagreed in a substantial number of patients, with pathological upstaging and significant differences regarding survival. With relation to T staging, there were no significant differences regarding survival. We should be aware of staging disagreements since they can have significant implications on the treatment and prognosis of cancer patients.

Evaluation of metastasis and 5-year survival in oral squamous cell carcinoma patients in Isfahan (2001-2015)

BACKGROUND

Frequency analysis of metastasis in patients with oral squamous cell carcinoma (OSCC) helps to partly anticipate the upcoming chance of metastasis in the patients following primary diagnosis. This study was conducted to determine the evaluation of metastasis and 5-year survival in OSCC.

MATERIALS AND METHODS

This was a retrospective, descriptive study. A total of 96 OSCC patients were studied. Demographic data and clinical view of lesion as well as histopathological grade of patients were recorded in previously prepared forms of pathology centers. These findings were then evaluated in relation to the 5-year survival. The obtained data were fed into SPSS and analyzed by Chi-square test, t-test, one-way ANOVA, and Scheffé test. A significant level of α = 0.05 was used.

RESULTS

The 5-year survival of patients was 41.7%. From among the patients, 44% were found to have local recurrence and 36% were reported to have distant metastasis. There was no significant association between the 5-year survival rate and primary grade (P = 0.105). However, it revealed a significant relationship between the 5-year survival rate and distant metastasis (P = 0. 001).

CONCLUSION

This study showed that the 5-year survival is dependent on the primary site of involvement, local recurrence, regional and distant metastasis, and mean age. However, gender (P = 0.89), grade (P = 0.105), and stage (P = 0.242) have no effect on the 5-year survival of patients.

Is Rajyoga helpful in maintaining patient's biochemical and hematological profile during breast cancer treatment?

The present study is the case of a breast cancer patient who visited the local unit of the Brahma Kumaris (BK). Conversations with the patient revealed that the patient was being treated in the Post Graduate Institute of Medical Education and Research, Chandigarh, India. The treatment of the patient included the surgery, radiotherapy, and chemotherapy. The patient narrated her ability to manage the psychological stress associated with the cancer treatment. She ascribed it to the positive attitude developed by her practice of the Rajyoga meditation from last 15 years. Rajyoga involved the daily meditation and regular listening to the specified commentary recommended by BK. Patient's health remains stable during the whole treatment process as analyzed by the mammography, histopathology and PET scan. The patient was also able to maintain the total body weight, biochemical and hematological profile within normal physiological range. The present case study is an attempt to provide Rajyoga as supportive means to the maintenance of patient's biochemical and hematological profile, and overall general health during breast cancer treatment.

Clinicopathological evaluation and survival of patients with squamous cell carcinoma of the tongue

Background

Early detection of oral cancer is the most effective means of reducing morbidity, complexity, and extent of treatment. This study evaluated the clinicopathological profile of epidermoid carcinoma of the tongue, including treatment and survival.

Material and Methods

This observational, retrospective cross-sectional study evaluated patients with squamous cell carcinoma of the tongue treated at the Dr. Luiz Antônio Hospital, Natal, Brazil, from January 2001 to December 2011. Survival variables were calculated using the Kaplan-Meier method and compared by log rank tests.

Results

Of the 412 patients diagnosed in this period, 298 (72.3%) were men; their mean age was 60.5 years, and 69.2% were diagnosed with stage III/IV tumours. Improved survival was associated with early stage diagnosis, absence of affected lymph nodes at diagnosis, and treatment with surgery alone.

Conclusions

Late stage diagnosis of oral cancer negatively affects patient survival. In addition, the general public should be made aware of the prognostic factors for oral SCC of the tongue and of the importance of periodic examinations of the oral cavity.

Key words:Mouth neoplasms, tongue neoplasms, carcinoma, squamous cell, survival analysis.