Correlation Between Clinical and Histological Staging in Laryngeal Cancer

Abstract

Clinical staging of human cancer is widely accepted as an effective and acceptable means of predicting prognosis and comparing treatment modalities. Consequently, intrinsic and unknown errors in such classifications may be erroneously construed as supporting forms of therapy which infact may be less rather than more effective than expected. Unfortunately, it is not possible to measure the inherent accuracy of many classifications. The larynx is an exception, and this paper is devoted to a comparison between clinical and histological staging in 145 laryngectomised patients. This detailed and time consuming examination was carried out by myself during the years 1965–1975 as part of a more extensive personal research programme devoted to the natural history and surgical pathology of laryngeal and hypopharyngeal cancer. However, identifying the intrinsic, and possibly unavoidable errors in any specific classification system, is only one part of the clinical problem. These 145 patients were then followed up for a minimum of 5 years in order that the significance of these errors might be determined in relation to long term survival. Such an analysis has never been carried out for laryngeal cancer, nor in fact for any other site within the head and neck. Indeed, it is probable that the exercise will never be repeated since the cost and time involved is prohibitive.