We appreciate the opportunity to continue the discussion on the concordance between clinical (cTNM) and pathological (pTNM) staging in oral cavity cancer (OCC) and thank Abasi and Zare for their insightful comments (van Oorschot et al. 2025; Abasi and Zare 2026). Their observations raise important considerations regarding diagnostic strategies, research methodology, benchmarking hospital outcomes, and the organization of oncology networks. We agree that comparing outcomes across hospitals may help identify which diagnostic approaches most accurately predict pathological stage. If similar outcomes can be achieved using different modalities, national protocols could base the choice of preferred diagnostics on additional considerations such as cost-effectiveness and radiation exposure. This is for instance relevant for cT1 tongue tumors, where omission of radiological imaging may yield outcomes comparable to those achieved with magnetic resonance imaging. Given the increasing workload of radiology departments, careful optimization of imaging resources is warranted. We also support the proposed use of adaptive staging in clinical trials to address stage migration. In this context, we would like to emphasize that differences between hospitals are often insufficiently accounted for in outcome analyses. As large, multicenter datasets become more widely used, it is essential to consider data clustering at the hospital level. Statistical approaches such as multivariable adjustment or multilevel modeling may help address these differences and improve the robustness of research findings (Samoli et al. 2021). Abasi and Zare further highlight the value of feedback mechanisms to benchmark hospital performance in staging accuracy. In the Netherlands, the Dutch Head and Neck Audit (DHNA) benchmarks outcomes across all 14 head and neck cancer centers, providing structured feedback to participating hospitals. In addition, a predefined set of quality indicators is publicly reported each year to promote transparency for stakeholders (Zorginstituut Nederland, n.d.). As expectations for open reporting of healthcare outcomes continue to grow, nationwide participation in such initiatives represents an important step forward. However, to translate benchmarking into meaningful quality improvement, standardized and validated methodologies are essential (Thurell et al. 2025). Finally, oncology networks such as the DHNA offer important opportunities to improve cancer care. To ensure these networks truly benefit patients, policies should focus on patient-centered measures and encourage collaboration between academic and non-academic centers (van der Ven et al. 2025). Further research is needed to optimize the structure and impact of these networks, particularly as international collaboration and large-scale data sharing continue to expand. Hanneke Doremiek van Oorschot: conceptualization, writing – original draft, writing – review and editing. Jose Angelito Hardillo: supervision, writing – review and editing, conceptualization. Robert Jan Baatenburg de Jong: supervision, writing – review and editing, conceptualization. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Oorschot et al. (Fri,) studied this question.