Zocchi Jacopo, Campa Matteo, Bianchi Giulia, Iocca Oreste, Di Maio Pasquale, Petruzzi Gerardo, Moretto Silvia, Campo Flaminia, De Virgilio Armando, Vander Poorten Vincent, Pellini Raul
Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy.
Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, 20142 Milan, Italy.
J Clin Med. 2022 Aug 22;11(16):4924. doi: 10.3390/jcm11164924.
Adenoid cystic carcinoma (AdCC) is a rare tumor whose clinical course is burdened by local recurrence and distant dissemination. Lymph node metastasis is not believed to be common and its clinical impact is controversial. The aim of this study was to determine: (1) the prevalence of occult metastasis at diagnosis in cN0 head and neck AdCC, (2) its prognostic role, and (3) the consequent need to perform elective neck dissection (END). A systematic review and meta-analyses following PRISMA guidelines was performed. PubMed, Embase, and Central databases were questioned up to July 2021 to identify studies reporting on the prevalence of occult neck metastases in head and neck AdCC. A single-arm meta-analysis was then performed to determine the pooled prevalence of occult lymph node metastases among the retained studies. Of the initial 6317 studies identified, 16 fulfilled the inclusion criteria, and they were included in the meta-analysis. Of a population of 7534 patients, 2530 cN0 patients were treated with END, which revealed 290/2530 cases of occult metastases (pN+/cN0). Meta-analysis of the results of END in the 16 studies estimated an overall prevalence of occult metastases at diagnosis of 17%. No further subgroup analysis was possible to identify factors influencing lymph node involvement and the prognostic role of END. Taking 20% as an historically proposed cut off, a 17% prevalence of occult metastases represents a borderline percentage to get a definitive conclusion about the indication to END for head and neck AdCC. A more advanced UICC stage, an oropharyngeal minor salivary glands origin, and a high-grade transformation are factors to be considered in a comprehensive patient's tailored therapeutic strategy. Multicenter prospective studies are the key to finding stronger recommendations on this topic.
腺样囊性癌（AdCC）是一种罕见肿瘤，其临床病程受局部复发和远处转移困扰。淋巴结转移被认为并不常见，其临床影响存在争议。本研究的目的是确定：（1）cN0头颈部AdCC诊断时隐匿性转移的发生率，（2）其预后作用，以及（3）随之而来的进行择区颈清扫术（END）的必要性。按照PRISMA指南进行了系统评价和荟萃分析。检索了截至2021年7月的PubMed、Embase和Central数据库，以识别报告头颈部AdCC隐匿性颈部转移发生率的研究。然后进行单臂荟萃分析，以确定纳入研究中隐匿性淋巴结转移的合并发生率。在最初识别的6317项研究中，16项符合纳入标准，并被纳入荟萃分析。在7534例患者中，2530例cN0患者接受了END治疗，其中发现290/2530例隐匿性转移（pN+/cN0）。对16项研究中END结果的荟萃分析估计，诊断时隐匿性转移的总体发生率为17%。无法进行进一步的亚组分析以确定影响淋巴结受累的因素以及END的预后作用。以历史上提出的20%作为临界值，17%的隐匿性转移发生率是一个临界百分比，难以对头颈部AdCC进行END的指征得出明确结论。更高级别的国际抗癌联盟（UICC）分期、口咽小涎腺起源和高级别转化是综合患者个体化治疗策略中应考虑的因素。多中心前瞻性研究是就该主题找到更强有力建议的关键。
