Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck A Systematic Review and Meta-analysis
Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck A Systematic Review and Meta-analysis
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DOI：
10.1001/jamaoto.2016.1281
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发表时间：
2016-09-01
影响因子：
7.8
通讯作者：
Fliss, Dan M.
中科院分区：
文献类型：
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作者：
Abu-Ghanem, Sara;Yehuda, Moshe;Fliss, Dan M.
早期T1-T2期口腔舌鳞癌（OTSCC）患者颈部淋巴结转移（cN0）无临床或放射学证据的选择性治疗在过去30年中一直是争论的主题，并且仍然存在争议。目的对早期T1-T2期OTSCC和cN0颈部患者择期颈清扫（END）与观察的文献进行系统回顾和meta分析。在MEDLINE、Scopus、谷歌scholar和Cochrane数据库中系统检索1970年1月1日至2015年6月1日之间发表的文章。搜索词为：鳞状细胞癌、口腔舌、活动舌、T1、T2、早期、择期颈部清扫、无颈部治疗、观察、等待观察、淋巴结阴性颈部、无颈部。研究选择：对照临床试验、前瞻性和回顾性队列、病例对照研究和病例系列，将没有临床或放射学证据表明淋巴结转移到颈部的早期T1-T2 OTSCC患者的END与观察进行比较，符合纳入本荟萃分析的条件。所有患者均经组织病理学诊断为鳞状细胞癌，随访至少6个月。检测区域（颈部）淋巴结复发、总生存期（OS）和疾病特异性生存期（DSS）。4位研究者独立地提取了关于人群特征、研究结果和研究设计的信息。分歧经协商一致解决。固定效应用于确定风险比（hr），优势比（ORs）用于包括没有实质性异质性的样本的研究；对具有显著异质性的样本进行随机效应评估。结果meta分析共纳入符合纳入标准的20项回顾性随机研究和3项前瞻性随机研究，共3244例患者。结果显示，与观察治疗相比，END显著降低了局部复发风险（随机效应模型：OR， 0.32; 95% CI, 0.22-0.46; P < .001），改善了DSS（固定效应模型：HR， 0.49; 95% CI, 0.33-0.72; P < .001）。然而，END并没有显著改善OS（随机效应模型：HR， 0.71; 95% CI, 0.41-1.22; P = 0.21）。本系统综述和荟萃分析的结果表明，END可以显著降低cT1T2N0 OTSCC患者的区域淋巴结复发率，改善DSS。
IMPORTANCE The elective management of no clinical or radiologic evidence of lymph node metastasis in the neck (cN0) in early stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial.OBJECTIVE To systematically review the literature and carry out ameta-analysis of studies that compared elective neck dissection (END) with observation in patients with early-stage T1-T2 OTSCC and cN0 neck.DATA SOURCES The MEDLINE, Scopus, Google scholar, and Cochrane databases were systematically searched for articles published between January 1, 1970, and June 1, 2015. Search terms used were squamous cell carcinoma, oral tongue, mobile tongue, T1, T2, early stage, elective neck dissection, no neck treatment, observation, wait and watch, node-negative neck, and N0 neck.STUDY SELECTION Controlled clinical trials, prospective and retrospective cohorts, case-control studies, and case series that compared END with observation in patients with early-stage T1-T2 OTSCC who had no clinical or radiologic evidence of lymph node metastasis to the neck were eligible for inclusion in this meta-analysis. All patients included had a histopathologic diagnosis of SCC and at least 6 months of follow-up. Regional (neck) nodal recurrence, overall survival (OS), and disease-specific survival (DSS) were tested.DATA EXTRACTION AND SYNTHESIS Four researchers independently extracted information on population characteristics, outcomes of interest, and study design. Discrepancies were resolved by consensus. Fixed effects were used to determine hazard ratios (HRs) and odds ratio (ORs) were used for studies including samples without substantial heterogeneity; random effects were evaluated for samples with significant heterogeneity.RESULTS A total of 20 retrospective and 3 prospective randomized studies that met the inclusion criteria, with a total of 3244 patients, were included in the meta-analysis The results showed that END significantly reduced risk of regional recurrence (random-effects model: OR, 0.32; 95% CI, 0.22-0.46; P < .001) and improved DSS (fixed-effects model: HR, 0.49; 95% CI, 0.33-0.72; P < .001) compared with management by observation. However, END did not significantly improve OS (random-effects model: HR, 0.71; 95% CI, 0.41-1.22; P = .21).CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-analysis indicate that END can significantly reduce the rate of regional nodal recurrence and improve DSS in patients with cT1T2N0 OTSCC.