Objectives: To compare the results of clinical and pathological staging for a large cohort of patients with head and neck squamous cell carcinoma (HNSCC) and to examine patterns and ramifications of the disparity between staging methods. Design: Prospective inception cohort (median follow-up, 7 years). Setting: Multi-institutional cooperative group study (Eastern Cooperative Oncology Group 4393/Radiation Therapy Oncology Group 9614) involving 17 academic medical centers. Patients: A total of 560 patients with new-onset or recurrent HNSCC enrolled during a 7-year period. Interventions: Surgical resection with curative intent with or without adjuvant or previous radiotherapy or chemotherapy. Main Outcome Measures: Clinical staging and pathological staging and the component TN tumor categories were compared with overall and disease-specific survival. Association of survival with staging was derived by means of the proportional hazards model. Results: Of the 501 cases in which both clinical and pathological staging was available, a disparity was found between at least 1 component tumor category assigned by the 2 methods in almost 50% of cases. Both methods showed a strong association of stage with overall survival for the cohort at large. However, pathological nodal category was a superior predictor (P<.001 vs P=.005), whereas there was an advantage to pathological tumor category in predicting disease-specific survival (P=.01). Conclusions: Both staging methods are useful in predicting survival, whereas information gained at neck dissection regarding nodal metastases provides some refinement in prognostic results. These findings demonstrate the need for enhanced methods of tumor assessment and apparent benefit of data gathered at neck dissection for accurate disease assessment and stratification.
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