Background/Objectives: Laryngeal squamous cell carcinoma (LSCC) is one of the most prevalent and challenging malignancies of the head and neck. Clinical staging (cTNM) plays a pivotal role in therapeutic decision-making. However, current imaging modalities often fall short, resulting in discrepancies between cTNM and pathological staging (pTNM). This systematic review aimed to critically evaluate the existing literature on the concordance between clinical and pathological staging of LSCC, quantifying staging inaccuracies and highlighting the prevalence of both under- and overstaging at diagnosis.Methods: A comprehensive search of the English-language literature was conducted across multiple databases, including PubMed, Embase, Scopus, the Cochrane Library, and Web of Science. Eligibility was limited to retrospective case series and observational studies reporting sufficient data to directly correlate individual patients’ cTNM and pTNM classifications.Results: Thirty-one studies comprising 7939 patients met the inclusion criteria. The overall concordance rate between cT and pT was approximately 86.43%. The concordance rates between cT and pT were 82.41%, 82.03%, 78.14%, and 89.64% for cT1, cT2, cT3, and cT4, respectively. Most discordant cases in cT2 and cT3 involved understaging at clinical diagnosis.Conclusions: The limited accuracy of clinical staging in reflecting the true extent of disease remains a critical challenge in the management of LSCC. The inability of current imaging techniques to reliably detect the subtle invasion of key anatomical structures contributes to both under- and overstaging, with significant clinical implications. For patients undergoing non-surgical organ-preservation strategies, these inaccuracies may adversely affect oncologic outcomes.
背景/目的：喉鳞状细胞癌（LSCC）是头颈部最常见且最具挑战性的恶性肿瘤之一。临床分期（cTNM）在治疗决策中起着关键作用。然而，现有影像学方法常存在不足，导致cTNM与病理分期（pTNM）之间存在差异。本系统综述旨在批判性评估关于LSCC临床分期与病理分期一致性的现有文献，量化分期不准确性，并揭示诊断中分期不足与分期过度的普遍情况。 方法：在多个数据库（包括PubMed、Embase、Scopus、Cochrane图书馆和Web of Science）中对英文文献进行全面检索。纳入标准限定为回顾性病例系列和观察性研究，这些研究需报告足够数据以直接关联个体患者的cTNM与pTNM分类。 结果：共31项研究符合纳入标准，涉及7939例患者。cT与pT的总体一致率约为86.43%。cT1、cT2、cT3和cT4分期中cT与pT的一致率分别为82.41%、82.03%、78.14%和89.64%。cT2和cT3分期中的大多数不一致病例涉及临床诊断时的分期不足。 结论：临床分期在反映疾病真实范围方面的准确性有限，这仍然是LSCC治疗中的关键挑战。现有影像技术无法可靠检测关键解剖结构的细微浸润，导致分期不足与分期过度并存，具有重要的临床意义。对于接受非手术器官保留策略的患者，这些不准确性可能对肿瘤学结局产生不利影响。
Clinical and Pathological Staging Discrepancies in Laryngeal Cancer: A Systematic Review
肿瘤(癌症)患者之家