Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Otolaryngol Head Neck Surg. 2019 Jun 1;145(6):542-548. doi: 10.1001/jamaoto.2019.0784.
The rate of skip metastasis to neck level IV in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC) remains controversial.
To provide a high level of evidence using a meta-analysis on the rate of skip metastasis to level IV in this subset of patients.
The Embase, PubMed, and Google Scholar databases were searched for articles published during the period of January 1, 1970, through December 31, 2017, using the following key terms: neck dissection, N0 neck, squamous cell carcinoma, skip metastasis, radical neck dissection, lymph node management, neck metastasis, oral cavity cancer, and tongue cancer. Some terms were also used in combination, and the reference section of each article was searched for additional potentially relevant publications. Data were analyzed from January 8 through 11, 2018.
Inclusion criteria were all cohorts, including from any randomized clinical trial, case-control study, case study, and case report; studies of patients with the histopathologic diagnosis of OCSCC; and studies that differentiated data between skip metastasis and sequential metastasis to neck level IV. Of the 115 articles retrieved from the literature, 11 retrospective studies and 2 prospective randomized clinical trials (n = 1359 patients) were included.
Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Fixed-effects model and 95% CIs were estimated, and data of included studies were pooled using a fixed-effects model.
Overall proportion of neck involvement and the rate of level IV skip metastasis. Subgroup analysis for primary site and tumor staging.
The rate of level IV involvement in patients with cN0 ranged between 0% and 11.40% with a fixed-effects model of 2.53% (95% CI, 1.64%-3.55%). The rate of skip metastasis ranged from 0% to 5.50% with a fixed-effects model of 0.50% (95% CI, 0.09%-1.11%). The rate of level IV skip metastasis did not increase significantly in cases that involved neck levels I through III. Tumor staging and primary site tumor did not significantly affect the rate of skip metastasis.
This meta-analysis showed very low rates of skip metastasis to neck level IV in patients diagnosed with cN0 OCSCC. Encountering an allegedly positive lymph node during neck dissection does not portend high rates of level IV involvement. Supraomohyoid neck dissection is therefore adequate for this subset of patients.
临床颈部淋巴结阴性（cN0）口腔鳞状细胞癌（OCSCC）患者颈部 IV 水平跳跃性转移的发生率仍存在争议。
使用荟萃分析提供该亚组患者 IV 水平跳跃性转移率的高证据水平。
从 1970 年 1 月 1 日至 2017 年 12 月 31 日，通过使用以下关键词在 Embase、PubMed 和 Google Scholar 数据库中搜索文章：颈清扫术、N0 颈部、鳞状细胞癌、跳跃性转移、根治性颈清扫术、淋巴结管理、颈部转移、口腔癌和舌癌。还结合使用了一些术语，并对每篇文章的参考文献部分进行了搜索，以查找其他可能相关的出版物。数据分析于 2018 年 1 月 8 日至 11 日进行。
纳入标准为所有队列，包括来自任何随机临床试验、病例对照研究、病例研究和病例报告的队列；组织病理学诊断为 OCSCC 的患者的研究；以及区分颈部 IV 水平跳跃性转移和顺序转移数据的研究。从文献中检索到的 115 篇文章中，纳入了 11 项回顾性研究和 2 项前瞻性随机临床试验（n=1359 名患者）。
遵循观察性研究的流行病学指南进行荟萃分析。估计固定效应模型和 95%置信区间，并使用固定效应模型汇总纳入研究的数据。
颈部受累的总体比例和 IV 水平跳跃性转移的发生率。原发部位和肿瘤分期的亚组分析。
cN0 患者颈部 IV 水平受累率为 0%至 11.40%，固定效应模型为 2.53%（95%CI，1.64%-3.55%）。跳跃性转移率为 0%至 5.50%，固定效应模型为 0.50%（95%CI，0.09%-1.11%）。涉及颈 I 至 III 水平的病例中，IV 水平跳跃性转移的发生率并未显著增加。肿瘤分期和原发部位肿瘤并未显著影响跳跃性转移的发生率。
这项荟萃分析表明，临床诊断为 cN0 OCSCC 的患者颈部 IV 水平跳跃性转移的发生率非常低。在颈清扫术中遇到据称阳性的淋巴结并不预示着 IV 水平的高受累率。因此，对于这亚组患者， supraomohyoid 颈清扫术是足够的。
