Neck observation is appropriate in T1–2, cN0 oral squamous cell carcinoma without perineural invasion or lymphovascular invasion

Yeh, Chien Fu; Li, Wing Yin; Yang, Muh Hwa; Chu, Pen–Yuan; Lu, Yen Ting; Wang, Yi Fen; Chang, Peter Mu Hsin; Tai, Shyh Kuan

doi:10.1016/j.oraloncology.2014.06.002

Cited by 32 publications

(32 citation statements)

References 36 publications

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“…The high pooled negative predictive value implied that only 6% of SLN-negative early oral cavity cancer patients would result in a false-negative regional recurrence during follow-up. This is similar to the regional recurrence rate after elective neck dissection in clinically neck-negative early OSCC reported by previous literature [80], and is far lower than the acceptable threshold of 20% cervical lymph node metastasis rate for prophylactic neck dissection. Therefore, elective neck dissection could be omitted in SLN-negative early OSCC patients.…”

Section: Discussionsupporting

confidence: 89%

Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies

et al. 2017

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ObjectivesThe diagnostic efficacy of sentinel lymph node biopsy(SLNB) in early oral squamous cell carcinoma(OSCC) still remains controversial. This meta-analysis was conducted to assess the diagnostic value of SLNB in clinically neck-negative T1-2 OSCC.MethodsA systematic literature search for relevant literature published up to September 11, 2016 was conducted in PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials, and the reference lists of eligible studies were examined. Data from different studies were pooled to estimate the summary sentinel lymph node(SLN) identification rate, sensitivity, negative predictive value. Summary receiver operator characteristic curve(SROC) was plotted and area under the SROC curve (AUC) was calculated to evaluate the overall diagnostic efficacy. Threshold effect was assessed with use of the spearman correlation coefficient. Between-study heterogeneity was tested using the Q tests and the I2 statistics. Subgroup analyses were conducted in view of the greater effect of different study characteristics on diagnostic efficacy of SLN. Deeks’ funnel plot asymmetry test was performed to evaluate publication bias. Sensitivity analysis was evaluated through omitting studies one by one and comparing the pooled results of random-effects model and fixed-effects model. All analyses were performed using Review Manager (version 5.3.5), Meta-DiSc (version 1.4), Comprehensive Meta Analysis (version 2.0) and STATA (version 12).Results66 studies comprising 3566 patients with cT1-2N0 OSCC were included in this meta-analysis. The pooled SLN identification rate was 96.3%(95% CI: 95.3%-97.0%). The pooled sensitivity was 0.87 (95% CI: 0.85–0.89), pooled negative predictive value was 0.94 (95% CI: 0.93–0.95), and AUC was 0.98 (95% CI: 0.97–0.99). Subgroup analyses indicated that SLN assessment with immunohistochemistry(IHC) achieved a significantly higher sensitivity than without IHC.ConclusionsThis meta-analysis suggests that SLNB has a high diagnostic accuracy in cT1-2N0 oral squamous cell carcinoma, and is an ideal alternative to elective neck dissection. Furthermore, the use of IHC can significantly improve SLNB diagnostic sensitivity for early OSCC.

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Section: Discussionsupporting

confidence: 89%

Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies

et al. 2017

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“…Thirty‐nine studies assessed occult nodal metastasis in patients with cN0 T1 and T2 of oral SCC who underwent END (Table ), with five RCTs and 34 retrospective studies. The rate of occult metastasis in patients with cN0 ranged from 20.6% to 49% in the RCTs, and 7.3% to 39.2% in the retrospective series.…”

Section: Resultsmentioning

confidence: 99%

Management of N0 neck in early oral squamous cell carcinoma: A systematic review and meta‐analysis

et al. 2018

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Objective The role of elective neck dissection (END) in patients with stage I (T1N0) and II (T2N0) squamous cell carcinoma of the oral cavity remains a controversial topic. We investigate the need for END by establishing a true incidence of occult nodal disease as a function of T stage Data Sources MEDLINE, Google Scholar, Scopus. Review Methods Studies were selected using a set of inclusion and exclusion criteria. Meta‐analysis using a random‐effects model was employed to generate an odds ratio (OR) comparing the incidence of occult metastasis between T1 and T2 tumors, as well as regional recurrence rates between patients receiving END versus observation. Results Thirty‐nine publications comprising five randomized controlled trials and 34 retrospective studies were selected for inclusion, yielding over 4,300 patients for analysis. The overall incidence of occult nodal metastasis, weighted by study size, was found to be 23%. Patients with T2 tumors have a significantly higher odds of having occult nodal disease (OR: 2.6, 95% confidence interval [CI]: 2.0‐3.4) over patients with T1 tumors. We also demonstrate that for patients who are observed, the odds of recurrence are significantly higher (OR: 4.18, 95% CI: 2.78‐6.28) compared to those who undergo END, although statistically significant interstudy heterogeneity was observed. Conclusions END should be reserved for stage II tumors given the significantly higher rate of occult metastasis. Observation may be more appropriate for stage I cancers. Laryngoscope, 129:E284–E298, 2019

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“…Perineural invasion (PNI), the histologic finding of nerve invasion by tumor cells, is generally accepted as a poor prognostic factor in head and neck squamous cell carcinoma (HNSCC) and has been associated with increased locoregional recurrence and decreased survival . PNI has also been shown to predict concurrent cervical lymph node metastasis, an important negative prognostic factor in early oral cavity cancer . However, the optimal treatment regimen for patients with early head and neck cancer with PNI remains a topic of significant debate …”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiotherapy for early head and neck squamous cell carcinoma with perineural invasion: A systematic review

2015

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Perineural invasion (PNI) is widely regarded as a negative prognostic factor in head and neck squamous cell carcinoma (HNSCC). Treatment guidelines recommend adjuvant radiotherapy (RT) for patients with adverse pathologic features, including PNI. The purpose of this study was to systematically review the literature to determine if patients with PNI as their only indication for adjuvant therapy benefit from adjuvant RT. In total, 339 abstracts were reviewed for relevance leaving 85 articles, which were evaluated in detail. Thirteen retrospective studies addressed the role of adjuvant RT for patients with PNI. Evidence is lacking to recommend adjuvant RT for all patients with HNSCC with PNI. However, the literature suggests that large nerve or multifocal PNI may predict worse outcome and may be a more appropriate indication for adjuvant therapy. We advocate that patients decide whether to undergo adjuvant therapy after a discussion of the limitations of current evidence. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2350-E2357, 2016.

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Neck observation is appropriate in T1–2, cN0 oral squamous cell carcinoma without perineural invasion or lymphovascular invasion

Cited by 32 publications

References 36 publications

Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies

Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies

Management of N0 neck in early oral squamous cell carcinoma: A systematic review and meta‐analysis

Adjuvant radiotherapy for early head and neck squamous cell carcinoma with perineural invasion: A systematic review

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