Stage change from clinical N0 to pathological N+ neck: A retrospective analysis of 169 patients

Aim: To find the incidence of upstaging from clinical N0 to pathological N+ in our study. Materials and Methods: This retrospective analysis of 169 patients was performed from January 1, 2015, to December 31, 2015. Out of these 169 patients, 97 were operated. Histopathological records of 87 patients were available and hence, included in this study. Rest of the patients were excluded from the study. Results: In these 87 operated patients, 26 patients had upstaging of the disease based on nodal status histopathologically. Out of these 26 patients, 11 patients had clinically N0 necks; however, due to their T size, elective radical neck dissections were performed. Histopathological reports show pathologically N-positive neck with their stage to get upgraded from N0 to N+ which had a direct influence on postoperative treatment management of the patients influencing the prognosis. Tongue cancers were upstaged more with 46.15% compared to other sites followed by buccal mucosa cancers with 38.45%. Conclusion: Pathologic lymph node staging, based on a staging or elective radical neck dissection, should be considered for patients treated for squamous cell carcinoma of oral cavity to identify high-risk patients who may benefit from postoperative adjuvant therapy such as radiation/chemotherapy. Prospective studies in large numbers are still essential to validate these findings before pathologic lymph node staging is also included in standard tumor node metastasis staging criteria