Clinical vs. Pathological Staging in Oral Squamous Cell Carcinoma: Frequency of Misjudgment, Associated Risk Factors, and Impact on Survival Outcomes

Objectives: Accurate staging of oral squamous cell carcinoma (OSCC) is crucial for prognosis and treatment planning. This study evaluates clinical staging accuracy, identifies factors contributing to discrepancies, and examines their impact on survival, particularly with the rising role of neoadjuvant immunotherapy. Material and Methods: A retrospective analysis of 545 OSCC patients assessed concordance between clinical and pathological staging. Logistic regression identified risk factors for misjudgment, while Kaplan-Meier curves and Cox proportional hazards models evaluated survival outcomes. Results: T stage concordance was observed in 315 patients (57.79%), with 125 (22.93%) upstaged and 104 (19.08%) downstaged. N stage concordance occurred in 319 patients (58.53%), with 159 (29.17%) upstaged and 67 (12.29%) downstaged. The highest T stage concordance was seen in cT4a (76.55%) and cT1 (68.32%), while cN0 showed the highest N stage accuracy (74.21%). Histopathological factors, including grading, perineural invasion, and lymphovascular invasion, were significantly associated with staging misjudgment. N stage misjudgment (both upstaging and downstaging) significantly predicted worse overall survival, whereas T stage misjudgment did not impact survival. Conclusions: Significant discrepancies exist between clinical and pathological staging in OSCC. Integrating clinicopathological factors such as grading, perineural invasion, and lymphovascular invasion can improve staging accuracy and prognostic assessment. Clinical Relevance: These findings highlight the need for enhanced staging strategies to optimize patient outcomes.