#Early stage cancer lymph nodes in neck series

5, 37, 47, 48 However, other investigators favor elective neck dissection (END) at the time of treatment of the primary T1-T2 lesion of the tongue. 23, 46 According to this traditional “wait and see” policy, a cN0 neck should not be dissected in cases of cT1T2N0 OTSCC unless surgery involving the neck was being conducted for other reasons, such as for better access to the primary tumor, reconstruction requirements, or cases considered as being at high risk for developing cervical metastasis. 2 - 45 Some clinicians are of the opinion that care for patients with cT1T2N0 OTSCC should be managed conservatively with observation only. 1 The elective management of the clinically node-negative (cN0) neck in early-stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial. The tongue is the most frequent subsite for intraoral cancer among the European and US populations, accounting for 40% to 50% of oral cancers. Oral cavity cancer is the sixth most common cancer worldwide. However, END did not significantly improve OS (random-effects model: HR, 0.71 95% CI, 0.41-1.22 P = .21).Ĭonclusions and Relevance The findings of this systematic review and meta-analysis indicate that END can significantly reduce the rate of regional nodal recurrence and improve DSS in patients with cT1T2N0 OTSCC. Results A total of 20 retrospective and 3 prospective randomized studies that met the inclusion criteria, with a total of 3244 patients, were included in the meta-analysis The results showed that END significantly reduced risk of regional recurrence (random-effects model: OR, 0.32 95% CI, 0.22-0.46 P < .001) and improved DSS (fixed-effects model: HR, 0.49 95% CI, 0.33-0.72 P < .001) compared with management by observation. Fixed effects were used to determine hazard ratios (HRs) and odds ratio (ORs) were used for studies including samples without substantial heterogeneity random effects were evaluated for samples with significant heterogeneity. Discrepancies were resolved by consensus. Regional (neck) nodal recurrence, overall survival (OS), and disease-specific survival (DSS) were tested.ĭata Extraction and Synthesis Four researchers independently extracted information on population characteristics, outcomes of interest, and study design. All patients included had a histopathologic diagnosis of SCC and at least 6 months of follow-up.

#Early stage cancer lymph nodes in neck series

Study Selection Controlled clinical trials, prospective and retrospective cohorts, case-control studies, and case series that compared END with observation in patients with early-stage T1-T2 OTSCC who had no clinical or radiologic evidence of lymph node metastasis to the neck were eligible for inclusion in this meta-analysis. Search terms used were squamous cell carcinoma, oral tongue, mobile tongue, T1, T2, early stage, elective neck dissection, no neck treatment, observation, wait and watch, node- negative neck, and N0 neck. Objective To systematically review the literature and carry out a meta-analysis of studies that compared elective neck dissection (END) with observation in patients with early-stage T1-T2 OTSCC and cN0 neck.ĭata Sources The MEDLINE, Scopus, Google scholar, and Cochrane databases were systematically searched for articles published between January 1, 1970, and June 1, 2015. Importance The elective management of no clinical or radiologic evidence of lymph node metastasis in the neck (cN0) in early stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial. Shared Decision Making and Communication.

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