Surgical oncology and reconstruction
Elective Neck Dissection Versus Wait-and-Watch Policy for Oral Cavity Squamous Cell Carcinoma in Early Stage: A Systematic Review and Meta-Analysis Based on Survival Data

https://doi.org/10.1016/j.joms.2019.03.015Get rights and content

Purpose

Whether elective neck dissection (END) should be adopted for patients with clinically early-stage (cT1-2N0M0) oral cavity squamous cell carcinoma (OCSCC) remains debated. The aim of this systematic review was to compare the survival benefit of END with that of the wait-and-watch policy (WW) for patients with early-stage OCSCC based on survival data.

Materials and Methods

According to the inclusion criteria, an exhaustive search for eligible studies was conducted. The study inclusion and data extraction were performed by 2 reviewers independently. The risk of bias was assessed in duplicate using the Risk Of Bias In Nonrandomized Studies of Interventions instrument. The hazard ratio (HR) of the time-to-event data was extracted or estimated. RevMan 5.3 and STATA 15.1 were adopted for data synthesis.

Results

Of the 35 studies that were included, only 5 were assessed as having a low risk of bias. Results of the meta-analyses showed END could significantly decrease neck recurrence (relative risk = 0.45; confidence interval [CI], 0.35-0.59; P < .00001) and improve disease-free survival (HR = 0.55; CI, 0.42-0.71; P < .00001), overall survival (HR = 0.75; CI, 0.64-0.86; P < .0001), and disease-specific survival (HR = 0.76; CI, 0.61-0.94; P = .01) compared with WW for patients with cT1-2N0. The subgroup analysis showed that END could decrease neck recurrence (P < .00001) and improve disease-free survival (P = .001) for patients with early-stage tongue cancer and that supraomohyoid neck dissection could decrease neck recurrence (P = .02). For patients with cT1N0, END could significantly decrease the proportion with neck recurrence (P = .0008) and improve disease-free survival (P = .0003), but the difference between overall survival and disease-specific survival did not achieve significance.

Conclusions

END can decrease recurrence and improve survival time for patients with early-stage OCSCC. More high-quality studies are needed to make a solid conclusion, especially for patients with cT1N0M0.

Section snippets

Materials and Methods

A protocol specifying the review method was established in advance. Two reviewers conducted the study inclusion, data extraction, and quality assessment independently and in duplicate. Any discrepancies were resolved through discussion.

Search Result

The search retrieved 3,860 search records. Sixty publications were evaluated as eligible after screening. After further evaluation of full texts, 20 publications were excluded for reasons listed in Supplement 3. Data from 5 publications overlapped with 5 other publications listed in Supplement 4; thus, these were regarded as only 5 studies. In total, 35 studies were included in this systematic review.3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 17, 18, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39,

Discussion

Once cervical lymph nodes are found to be metastatic during follow-up, salvage neck dissection cannot always save the patient and sometimes the salvage rate is lower than 40%.50 In some cases, prophylactic neck dissection was conducted simultaneously with ablation of the primary lesion to remove occult metastatic cervical lymph nodes. Notably, occult metastatic lymph nodes do not present in all patients with a clinically N0 neck; thus, some researchers believe END is unnecessary for patients

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    Yubin Cao and Tao Wang contributed equally to this work.

    This research is funded by the Health Bureau of Sichuan (18PJ094).

    Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

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