Cao Yubin, Wang Tao, Yu Changhao, Guo Xia, Li Chunjie, Li Longjiang
PhD Candidate, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
PhD Candidate, State Key Laboratory of Oral Diseases, West China College of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
J Oral Maxillofac Surg. 2019 Oct;77(10):2154-2167. doi: 10.1016/j.joms.2019.03.015. Epub 2019 Mar 27.
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.
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.
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.
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.
对于临床早期（cT1 - 2N0M0）口腔鳞状细胞癌（OCSCC）患者是否应采用选择性颈部清扫术（END）仍存在争议。本系统评价的目的是根据生存数据比较END与观察等待策略（WW）对早期OCSCC患者的生存获益。
根据纳入标准，对符合条件的研究进行全面检索。研究纳入和数据提取由2名研究者独立进行。采用干预性非随机研究的偏倚风险工具对偏倚风险进行重复评估。提取或估计事件发生时间数据的风险比（HR）。采用RevMan 5.3和STATA 15.1进行数据合成。
纳入的35项研究中，只有5项被评估为低偏倚风险。荟萃分析结果显示，与WW相比，END可显著降低颈部复发率（相对风险 = 0.45；置信区间[CI]，0.35 - 0.59；P <.00001），并改善无病生存期（HR = 0.55；CI，0.42 - 0.71；P <.00001）、总生存期（HR = 0.75；CI，0.64 - 0.86；P <.0001）和疾病特异性生存期（HR = 0.76；CI，0.61 - 0.94；P =.01），针对cT1 - 2N0患者。亚组分析显示，END可降低早期舌癌患者的颈部复发率（P <.00001）并改善无病生存期（P =.001），肩胛舌骨上颈部清扫术可降低颈部复发率（P =.02）。对于cT1N0患者，END可显著降低颈部复发比例（P =.0008）并改善无病生存期（P =.0003），但总生存期和疾病特异性生存期的差异未达到显著水平。
END可降低早期OCSCC患者的复发率并延长生存时间。需要更多高质量研究以得出确凿结论，尤其是对于cT1N0M0患者。
