Otorhinolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Eur Arch Otorhinolaryngol. 2020 Dec;277(12):3247-3260. doi: 10.1007/s00405-020-06090-9. Epub 2020 May 30.
To provide a summary of the evidence on the comparative effectiveness of two surgical treatment strategies, sentinel node biopsy (SNB) and elective neck dissection (END), in patients with T1-T2 oral cancer and clinically negative (cN0) neck, in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs).
A systematic review was performed by including studies published up to April 2019. Meta-analysis was performed to compare NRRs between SNB and END. A narrative summary of the results was generated for OS, DFS and morbidity outcomes. The certainty of evidence was assessed according to the GRADE methodology.
No randomized studies were retrieved. Five observational studies were included in the comparative effectiveness analysis and four observational studies were included in the comparative morbidity analysis. The pooled risk ratio showed no differences in NRRs between SNB and END (10.5% vs 11.6%; pooled RR 1.09; 95% CI 0.67-1.76). No differences in OS or DFS between the two treatments were found. SNB appears to be associated with a lower rate of postoperative complications and lower shoulder dysfunction than END. Conversely, the results of the quality of life (QoL) questionnaires are not sufficient to advocate a particular strategy.
Our review highlights the lack of well conducted and randomized studies comparing SNB to END, leading to poor clinical evidence. Although our findings suggest no significant differences in OS, DFS and NRR between the two strategies, the certainty of our evidence is too low to make it useful for clinical decision making.
总结 T1-T2 期口腔癌临床颈淋巴结阴性（cN0）患者行前哨淋巴结活检（SNB）和选择性颈清扫术（END）两种手术治疗策略的疗效比较，包括总生存率（OS）、无病生存率（DFS）和颈部复发率（NRR）。
系统检索截至 2019 年 4 月发表的相关研究，采用 Meta 分析比较 SNB 与 END 的 NRR 差异，对 OS、DFS 和并发症结局进行叙述性汇总。根据 GRADE 方法评估证据质量。
未检索到随机对照研究。纳入 5 项比较有效性研究和 4 项比较并发症研究。汇总风险比显示 SNB 与 END 的 NRR 无差异（10.5%比 11.6%；汇总 RR 1.09；95%CI 0.67-1.76）。两种治疗方法在 OS 和 DFS 方面无差异。SNB 术后并发症和肩部功能障碍的发生率低于 END，但生活质量问卷结果尚不足以支持某一特定策略。
本研究强调缺乏比较 SNB 与 END 的高质量随机对照研究，导致临床证据不足。尽管我们的研究结果表明两种策略在 OS、DFS 和 NRR 方面无显著差异，但证据质量太低，无法为临床决策提供有用信息。
