Sanabria Alvaro, Shah Jatin P, Medina Jesus E, Olsen Kerry D, Robbins K Thomas, Silver Carl E, Rodrigo Juan P, Suárez Carlos, Coca-Pelaz Andrés, Shaha Ashok R, Mäkitie Antti A, Rinaldo Alessandra, de Bree Remco, Strojan Primož, Hamoir Marc, Takes Robert P, Sjögren Elisabeth V, Cannon Trinitia, Kowalski Luiz P, Ferlito Alfio
Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia.
CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia.
Cancers (Basel). 2020 Apr 24;12(4):1059. doi: 10.3390/cancers12041059.
Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved.
All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis.
36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4-23.4) and 8.0% (95% CI 2.7-13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0-6.1%), 2.0% (95% CI 0.9-3.1) and 0.4% (95% CI 0-1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0-1.3).
The incidence of occult lymph node metastasis is higher in supraglottic and T3-4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
喉癌是上呼吸道消化道常见的肿瘤部位。对于临床上颈部阴性的病例，选择性颈部治疗的指征仍存在争议。目的是根据原发肿瘤的亚部位、T 分期及受累的颈部淋巴结水平来确定隐匿性转移的发生率。
纳入的所有研究均提供了 cN0 喉鳞状细胞癌患者隐匿性转移的发生率。主要结局为隐匿性转移的发生率。采用随机效应分析计算合并发生率。
36 项研究共 3803 例患者符合标准。声门上型和声门型肿瘤的淋巴结转移发生率分别为 19.9%（95%CI 16.4 - 23.4）和 8.0%（95%CI 2.7 - 13.3）。I 区、IV 区和 V 区隐匿性转移的发生率分别为 2.4%（95%CI 0 - 6.1%）、2.0%（95%CI 0.9 - 3.1）和 0.4%（95%CI 0 - 1.0%）。对于所有肿瘤，IIB 亚区的发生率为 0.5%（95%CI 0 - 1.3）。
声门上型和 T3 - 4 期肿瘤隐匿性淋巴结转移的发生率较高。I 区和 V 区以及 IIB 亚区在 cN0 喉癌的选择性颈部治疗中不应常规包括在内，此外，声门上型肿瘤病例中 IV 区也不应常规包括在内。
