Elective Neck Dissection Versus Observation in Squamous Cell Carcinoma of Oral Cavity With Clinically N0 Neck: A Systematic Review and Meta-Analysis of Prospective Studies

Ding, Zhangfan; Xiao, Tingying; Huang, Jie; Yuan, Yihang; Ye, Qingsong; Xuan, Ming; Xie, Huixu; Wang, Xiaoyi

doi:10.1016/j.joms.2018.08.007

Cited by 48 publications

(45 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thirteen SRs15,16,18–27,29 included a meta-analysis, and all SRs15–29 were published in English between 2010 and 2018. Nine SRs15,19,22–26,28,29 had focused on oral cavity cancer exclusively, whereas other six SRs16–18,20,21,27 had focused on head and neck cancers, with the oropharyngeal cancer being the most frequent among them. Eight SRs15,17,19,22,24,27–29 assessed surgical interventions, three SRs16,21,25 assessed radiotherapy, three SRs20,23,26 assessed chemotherapy and one SR18 assessed targeted therapy and immunotherapy.…”

Section: Resultsmentioning

confidence: 99%

“…Ten SRs15,19,22–29 scored “Critically low”, three SRs16,20,21 scored “Low” and only two SRs17,18 scored “High” methodological quality, according to the AMSTAR-2 critical appraisal criteria (Figure 2). The SRs were downgraded mainly because the SR authors did not explain their selection of the study designs for inclusion in the review,16–23,25–29 sources of funding for the included studies were not clearly stated,15,16,19,22–29 there was no reference to a protocol,15,19,22–29 and the list of excluded studies was not provided 15,19,22,24–27,29…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen SRs15,17–24,26–29 were conducted including 18 PICOs. Eight PICOs evaluated surgical interventions,17,19,22,24,27–29 five PICOs assessed chemotherapy,20,23,26 three PICOs assessed radiotherapy17,21 and two PICOs assessed immunotherapy. Eight PICOs were reported as “beneficial”, one PICO as “probably beneficial”, eight PICOs as “no differential effect” and one PICO was reported as “inconclusive” (Table 2).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer

Anaya¹,

Franco²,

Ballesteros³

et al. 2018

CMAR

View full text Add to dashboard Cite

Purpose: This evidence mapping aims to describe and assess the quality of available evidence in systematic reviews (SRs) on treatments for oral cancer. Materials and methods: We followed the methodology of Global Evidence Mapping. Searches in MEDLINE, EMBASE, Epistemonikos and The Cochrane Library were conducted to identify SRs on treatments for oral cancer. The methodological quality of SRs was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool. We organized the results according to identified Population-Intervention-Comparison-Outcome (PICO) questions and presented the evidence mapping in tables and a bubble plot. Results: Fifteen SRs met the eligibility criteria, including 118 individual reports, of which 55.1% were randomized controlled clinical trials. Ten SRs scored "Critically low" methodological quality. We extracted 30 PICOs focusing on interventions such as surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy; 18 PICOs were for resectable oral cancer, of which 8 were reported as beneficial. There were 12 PICOs for unresectable oral cancer, of which only 2 interventions were reported as beneficial. Conclusion: There is limited available evidence on treatments for oral cancer. The methodological quality of most included SRs scored "Critically low". The main beneficial treatment reported by authors for patients with resectable oral cancer is surgery alone or in combination with radiotherapy or chemotherapy. Evidence about the benefits of the treatments for unresectable oral cancer is lacking. These findings highlight the need to address future research focused on new treatments and knowledge gaps in this field, and increased efforts are required to improve the methodology quality and reporting process of SRs on treatments for oral cancer.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer

Anaya¹,

Franco²,

Ballesteros³

et al. 2018

CMAR

View full text Add to dashboard Cite

show abstract

“…However, compared with this meta-analysis, the latest RCT was not included in the 2 meta-analyses mentioned above, and a study by Vandenbrouck et al contained T3 patients. 5,49,50 In addition, the 2 meta-analyses used relative risk (RR) to analyze the differences in survival rates, ignoring the influences of time factor on the outcomes. In our meta-analysis, we used HR for survival analysis to remove the impacts of time and censored data for more comprehensive results.…”

Section: Discussionmentioning

confidence: 99%

Neck nodal recurrence and survival of clinical T1-2 N0 oral squamous cell carcinoma in comparison of elective neck dissection versus observation: A meta-analysis

Cai

Zhu

Wang

et al. 2020

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

View full text Add to dashboard Cite

Objective. The clinical management of patients with T1-2 oral squamous cell carcinoma (OSCC) and clinically node-negative neck (cN0) continues to be controversial. We performed a systematic review of the literature to assess the effect of elective neck dissection (END) and neck observation (OBS) on the prognosis of patients with cT1-2 N0 OSCC. Study Design. PubMed, Embase, and Cochrane Library were searched for studies related to END and OBS in patients with cT1-2 N0 OSCC. The Mantel-Haenszel method was used to pool odds ratios (OR) for neck nodal recurrence and hazard ratios (HR) for survival. Results. END reduced the risk of neck nodal recurrence (OR 0.45; 95% confidence interval 0.32À0.63; P < .00001) in cT1-2 N0 OSCC. The disease-free survival (HR 0.52; 95% CI 0.42À0.63; P < .00001) was significantly higher in patients treated with END. However, END failed to significantly improve overall survival (HR 0.83; 95% CI 0.67À1.04; P = .10) and disease-specific survival (HR 0.87; 95% CI 0.48À1.57; P = .65) compared with management by OBS. Conclusions. A reduction in neck nodal recurrence and an increase in disease-free survival might support the need for END in early-stage OSCC with clinically N0 neck. (Oral Surg Oral Med Oral Pathol Oral Radiol 2020;129:296À310)

show abstract

“…There is no method of imaging or other examination technique except histopathology that can detect microscopic foci of metastatic spread in cervical lymph nodes. Immunohistochemical and molecular analysis are superior for detecting occult metastases than light microscopy with ordinary hematoxylin and eosin staining [21][22]. When the probability of occult lymph node metastasis is more than 20%, the guidelines recommend END [23].…”

Section: Discussionmentioning

confidence: 99%

Occult Nodal Metastasis in Oral Cavity Cancers

Arain¹,

Rajput²,

Ansari³

et al. 2020

Cureus

View full text Add to dashboard Cite

Introduction: In squamous cell carcinoma (SCC) of the oral cavity, there is always a risk of occult metastasis to neck nodes in the clinically and radiologically negative neck (N0). Therefore, elective neck dissection (END) has ever been under discussion since the beginning of their routine use for the management of neck for oral carcinomas. The purpose of the current study is to identify the percentage of occult nodal metastasis to neck levels I-V in the cases of oral carcinoma who were treated for the N0 with END. Methods: Patients who were treated between June 2005 and May 2010 with END from neck levels I to V for the management of N0 with oral SCC had been identified from the database of Aga Khan University Hospital. Those who met the inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS 16 software. Using descriptive statistics, the mean was computed for the quantitative variable (age). Frequencies and percentages were calculated for gender, site, tumor grade, and lymph node involvement for each neck level. Results: A total of 50 patients were included in the study. There were 38 males and 12 females. The mean age was 47 (range 25-72). The most common site of the tumor was buccal mucosa in 50% of the cases followed by tongue 20%, then floor of mouth 14%, dentoalveolar ridge 8%, retromolar area 4%, lip 2%, and hard palate 2%. Histopathological grading of tumors showed well-differentiated 28%, moderately differentiated 33%, and poorly differentiated 6%. Twenty-seven out of 50 patients were found positive for nodal metastasis on final postoperative histopathology. Neck node metastasis at level I was found in 22 patients, at level II in 16 patients, at level III in seven patients, and at level IV in two patients. The level V was found free of metastasis in all of the cases. Conclusion: The rate of occult metastatic disease to the neck nodes was similar to that found in the literature. Both early and advanced local disease is associated with a risk of occult metastasis. END for neck levels I-V is, therefore, recommended for the management of the N0 in all cases of oral SCCs. Spread to levels IV and V is rare and these levels should not be a part of routine END.

show abstract

Elective Neck Dissection Versus Observation in Squamous Cell Carcinoma of Oral Cavity With Clinically N0 Neck: A Systematic Review and Meta-Analysis of Prospective Studies

Abstract: END substantially decreases recurrences and deaths related to regional recurrences in early-stage SCC of the oral cavity with clinically N0 neck, especially SCC of the oral tongue and floor of the mouth, which is necessary for such patients.

Cited by 48 publications

References 37 publications

Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer

Evidence mapping and quality assessment of systematic reviews on therapeutic interventions for oral cancer

Neck nodal recurrence and survival of clinical T1-2 N0 oral squamous cell carcinoma in comparison of elective neck dissection versus observation: A meta-analysis

Occult Nodal Metastasis in Oral Cavity Cancers

Contact Info

Product

Resources

About