The Same-Up-Down Staging System for Recurrent Early Glottic Cancer

Simple Summary Compared with other head and neck cancer types, the prognosis of recurrent early glottic cancer (rEGC) may be less dependent on the presence of regional (N) and/or distant metastases (M). The latter two are clinically infrequent due to rEGC's peculiar biology, but the currently available staging systems still rely upon these parameters. Thus, we developed a new staging system (SUD) centered on the comparison between the T stages of the recurrence and the primary tumor. Then, in our cohort of 258 patients with rEGC treated at our Institution in Florence, Italy, we verified how the SUD system performs in the prediction of the overall and disease-specific survival, compared to the other classifications already in use. (1) Background: The treatment of recurrent early glottic cancer (rEGC) remains challenging. We wanted to investigate how the oncological outcomes are affected by the initial and recurrent stages, in order to propose our newly developed Same-Up-Down (SUD) staging system. (2) Methods: In our cohort of 258 rEGC patients, we retrospectively assessed the prognostic performances of the rTNM (the TNM staging system for recurrence), CLRSS, CLRSS-2, and SUD staging systems by univariate and multivariate Cox analysis, comparing their predictive capability using Harrell's C-index. (3) Results: The SUD classification satisfactorily predicted both overall survival (p = 0.022) and second-recurrence-free survival (p = 0.024, as same + down vs. upstage) in our cohort. It also outperformed the other three systems in terms of prediction of survival, with an improvement of 1.52%, 1.18%, and 3.96% in the predictive capacity of overall survival, disease-specific survival, and second-recurrence-free survival, respectively. (4) Conclusions: The SUD staging system can efficiently predict survival in rEGC patients, whose prognosis heavily depends on both the initial and recurrent locoregional extension.