Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Medical College of Georgia, Augusta University, Augusta, GA, USA.
Ann Otol Rhinol Laryngol. 2021 Jan;130(1):67-77. doi: 10.1177/0003489420937744. Epub 2020 Jul 1.
The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck.
A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded.
Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, < .00001). Patients with OM were more likely to develop distant metastasis (OR = 5.65, 95% CI = 3.36-9.51, < .00001).
Patients with advanced T-stage laryngeal SCC should undergo elective neck treatment. More aggressive treatment for patients with history of OM should be considered due to the risk of subsequent regional and distant metastasis.
II.
喉鳞状细胞癌（SCC）隐匿性转移（OM）的发生率仍存在广泛争议。本系统评价旨在确定喉 SCC 隐匿性转移的发生率、其对复发的影响，以及选择性颈清扫术（END）在处理临床阴性颈部中的作用。
系统检索了 Web of Science、PubMed、MEDLINE 和 Cochrane Library 数据库中从 1977 年至 2018 年发表的关于喉 SCC 隐匿性转移的英文文献。纳入评估行手术治疗且临床颈部阴性的喉 SCC 患者隐匿性转移（OM）的研究。排除评估其他头颈部亚部位、临床淋巴结阳性和挽救性患者的研究。
共纳入 21 篇文章，总计 5630 例患者。总的 OM 发生率为 20.5%，声门上型和声带型肿瘤分别为 23%和 12.2%。T1-T2 肿瘤的 OM 发生率为 13%，T3-T4 肿瘤为 25%。与 T1-T2 肿瘤相比，T3-T4 肿瘤发生 OM 的可能性显著更高（优势比 [OR] = 2.61，95%置信区间 [CI] = 1.92-3.55， < .00001）。发生 OM 的患者更有可能发生远处转移（OR = 5.65，95% CI = 3.36-9.51， < .00001）。
对于晚期 T 期喉 SCC 患者，应行选择性颈部治疗。对于有 OM 病史的患者，应考虑更积极的治疗，因为其存在随后发生区域性和远处转移的风险。
II 级。
