Sentinel Lymph Node Biopsy Versus Elective Node Dissection in Stage cT1‐2N0 Oral Cavity Cancer

Abstract

Objective: To compare overall survival (OS) and disease-free survival (DFS) between sentinel lymph node biopsy (SNB) and elective neck dissection (END) in the surgical management of cT1-2N0 oral cavity squamous cell carcinoma (OCSCC).Methods: English full-text articles were searched in PubMed and Embase on May 9, 2021. Articles had to compare SNB with END in cT1-T2N0 OCSCC patients; report hazard ratios (HRs), Kaplan-Meier curves, or P-values with total number of events for survival outcomes; be from a clinical trial, cohort, or case-control study. Two reviewers reviewed articles and a third settled disagreements. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Risk of Bias in Non-randomized Studies of Interventions tool and revised Cochrane risk-of-bias tool for randomized trials were used. The generic inverse variance method with a random-effect model was used for meta-analysis.Results: Ten studies, five retrospective, three prospective, and two randomized controlled trials, were included (total number of patients [n] = 10,498, END n = 9102, SNB n = 1396). No significant differences were found in OS (HR = 0.92; 95% confidence interval [CI]: 0.65-1.31) or DFS (HR = 0.70; 95% CI: 0.41-1.20). Heterogeneity was not detected in pooled OS analysis (P = .18; I 2 = 30%), but was in pooled DFS analysis (P = .003; I 2 = 66%).Conclusions: No statistically significant differences in OS or DFS were observed between SNB and END in cT1-2N0 OCSCC, suggesting that SNB might be an alternative to END in the management of early-stage, clinically node-negative OCSCC.

Comparison of sentinel lymph node biopsy and elective neck dissection for oral cavity squamous cell carcinoma of the oral cavity in patients with clinically N0 necks: A systematic review and meta-analysis

“…However, they included only six prospective studies and did not discuss DSS. Saleem et al found no significant difference in DFS or OS between patients who underwent SNB and END (37). However, unlike our study, their DFS data were heterogeneous.…”

“…Thus, although the studies varied somewhat in terms of design and quality, the variations did not affect the results, and the survival outcomes of SNB and END were similar. In contrast to Saleem et al, we found no significant difference in OS, DFS, or DSS between SNB and END in any study (Figure 2), possibly because our subgroups were defined by follow-up period (3, 5, and 10 years) (9,37,39,40). Earlier meta-analyses did not perform subgroup analyses by follow-up period.…”

Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience

“…Recent years have seen a growing body of evidence to indicate that SNLB, with completion neck dissection where necessary, has similar patient survival outcomes as END for the management of the N0 neck in early stage OSCC 8–11,20 . Furthermore, cost and quality of life analyses appear to favour SNLB over END in these patients 12,21,22 .…”

“…Recent years have seen a growing body of evidence to indicate that SNLB, with completion neck dissection where necessary, has similar patient survival outcomes as END for the management of the N0 neck in early stage OSCC. [8][9][10][11]20 Furthermore, cost and quality of life analyses appear to favour SNLB over END in these patients. 12,21,22 Given these observations, several authorities recommend SLNB as the standard of care in cT1-2 N0 OSCC, while some professional bodies recommend that all patients with this disease should have access to the procedure.…”

Reply to T. Gupta et al

“…The size of the noninferiority margin was also pointed out by Lai et al 6 in 2020. Several meta-analyses 7,8 for SLNB indicated a nonsignificant difference in prognosis. Even if the overall survival were not equivalent, the difference would be too small to be detected by 550 patients on the two RCTs.…”