择期颈部清扫术与观察在早期口腔舌部鳞状细胞癌伴颈部无临床明显淋巴结转移中的应用：系统评价和荟萃分析。
Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck: A Systematic Review and Meta-analysis.
机构信息
Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel.
Faculty of Management, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
JAMA Otolaryngol Head Neck Surg. 2016 Sep 1;142(9):857-65. doi: 10.1001/jamaoto.2016.1281.
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.
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.
DATA SOURCES
The MEDLINE, Scopus, Google scholar, and Cochrane databases were systematically searched for articles published between January 1, 1970, and June 1, 2015. 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.
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. All patients included had a histopathologic diagnosis of SCC and at least 6 months of follow-up. Regional (neck) nodal recurrence, overall survival (OS), and disease-specific survival (DSS) were tested.
DATA EXTRACTION AND SYNTHESIS
Four researchers independently extracted information on population characteristics, outcomes of interest, and study design. Discrepancies were resolved by consensus. 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.
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. However, END did not significantly improve OS (random-effects model: HR, 0.71; 95% CI, 0.41-1.22; P = .21).
CONCLUSIONS 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.
重要性：在过去的 30 年中，早期 T1-T2 口腔舌鳞状细胞癌（OTSCC）颈部无临床或影像学证据的淋巴结转移（cN0）的选择性颈部管理一直存在争议，并且仍然存在争议。
目的：系统地回顾文献，并对比较早期 T1-T2 OTSCC 和 cN0 颈部 cN0 患者选择性颈部清扫术（END）与观察的研究进行荟萃分析。
数据来源：系统地检索了 MEDLINE、Scopus、Google Scholar 和 Cochrane 数据库，以获取 1970 年 1 月 1 日至 2015 年 6 月 1 日期间发表的文章。使用的搜索词包括鳞状细胞癌、口腔舌、活动舌、T1、T2、早期、选择性颈部清扫术、无颈部治疗、观察、等待和观察、阴性颈部淋巴结和 N0 颈部。
研究选择：本荟萃分析纳入了比较早期 T1-T2 OTSCC 患者 END 与观察的对照临床试验、前瞻性和回顾性队列研究、病例对照研究和病例系列研究，这些患者颈部无临床或影像学证据表明存在淋巴结转移。所有纳入的患者均有 SCC 的组织病理学诊断，且至少随访 6 个月。检测局部（颈部）淋巴结复发、总生存率（OS）和疾病特异性生存率（DSS）。
数据提取与综合：四位研究人员独立提取了人口统计学特征、感兴趣的结局和研究设计信息。通过协商解决了分歧。固定效应用于确定风险比（HR），而用于研究中包含无显著异质性样本的比值比（OR）；对于存在显著异质性的样本，评估随机效应。
结果：共有 20 项符合纳入标准的回顾性研究和 3 项前瞻性随机研究，共纳入 3244 名患者。结果表明，与观察相比，END 显著降低了区域性复发的风险（随机效应模型：OR，0.32；95%CI，0.22-0.46；P<0.001）和改善了 DSS（固定效应模型：HR，0.49；95%CI，0.33-0.72；P<0.001）。然而，END 并未显著提高 OS（随机效应模型：HR，0.71；95%CI，0.41-1.22；P=0.21）。
结论和相关性：本系统评价和荟萃分析的结果表明，END 可显著降低 cT1T2N0 OTSCC 患者的区域性淋巴结复发率并提高 DSS。
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