Comparison of Clinical and Pathological Staging in Head and Neck Squamous Cell Carcinoma

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Abstract
Clinical data regarding a large cohort of patients with head and neck squamous cell carcinoma (HNSCC) have been gathered through the auspices of 2 cooperative groups, the Eastern Cooperative Oncology Group (EGOG) and the Radiation Therapy Oncology Group (RTOG). Study ECOG 4393/RTOG 9614 has as its first objective to determine the clinical utility of molecular detection of cancer cells in tumor margins, which continues under analysis. An independent second objective of the protocol is to determine the incidence of TP53 (OMIM *191170) mutation in HNSCC and seek associations between TP53 status and clinical outcome. This analysis forms the basis of a recent publication.1 The current analysis was motivated by the observation that pathological N category, but not clinical T or N category, was associated with TP53 mutation status. The reasons for this variance were not immediately apparent, and so we set out to explore differences between the 2 staging paradigms. Our hypothesis was that pathological stage should correspond more faithfully to biological aggressiveness of disease, resulting ultimately in greater precision in predicting outcome. This study was undertaken to further elucidate the significance of clinical and pathological stage and the component T and N categories as prognostic factors for overall and disease-specific survival. This is, to our knowledge, the first such report in the literature to compare clinical and pathological stage in a large cohort of patients with HNSCC.