Elective neck dissection or "watchful waiting": optimal management strategy for early stage N0 tongue carcinoma using decision analysis techniques.
Elective neck dissection or "watchful waiting": optimal management strategy for early stage N0 tongue carcinoma using decision analysis techniques.
复制标题
选择性颈清扫术或“观察等待”：使用决策分析技术的早期 N0 舌癌的最佳管理策略。
DOI：
10.1097/00029330-200809010-00010
复制
发表时间：
2008
影响因子：
6.1
通讯作者：
Zhe Peng
中科院分区：
文献类型：
--
作者：
T. Song;N. Bi;L. Gui;Zhe Peng
背景
虽然舌癌是头颈部常见疾病，但对于早期N0期口腔舌癌患者，选择择期颈清扫术或“观察等待”颈部治疗仍存在争议。
方法
根据头颈部癌症的现状，建立了一个决策分析模型，用于比较早期舌癌的两种治疗策略。根据符合规定标准的文献计算预期值（EV）。进行了敏感性分析。
结果
结果表明，选择性颈清扫术（EV = 0.87）优于“观察等待”（EV = 0.77）。单因素敏感性分析表明，结果受局部复发的影响，选择性颈清扫组的阈值为0.28，“观察等待”组为0.17，“观察等待”组的挽救率阈值为0.73。
结论
结果提示，对于无淋巴结转移的早期N0口腔舌癌患者，应采用选择性颈淋巴结清扫术。当隐匿性淋巴结转移率小于0.17，挽救率大于0.73时，宜采用“警惕等待”策略。
BACKGROUND
Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage N0 oral tongue carcinoma.
METHODS
On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value (EV) was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed.
RESULTS
The results showed that the decision model favored elective neck dissection (EV = 0.87), over "watchful waiting" (EV = 0.77). One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group, and a salvage rate threshold value 0.73 for the "watchful waiting" group.
CONCLUSIONS
These results suggested that elective neck dissection strategy of the neck should be applied for early stage N0 oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, "watchful waiting" strategy would be preferable.