Mauramati Simone, Veneroni Maria Vittoria, Errico Eugenio, Canzi Pietro, Bertino Giulia, Robiolio Emanuele, Gelli Rebecca, Pedretti Fabio, Minuti Marta, Crea Rita, Benazzo Marco
Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico San Matteo, Pavia, PV, Italy.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2253-2261. doi: 10.1007/s00405-024-09145-3. Epub 2024 Dec 16.
The primary endpoint of the study was to quantitatively evaluate the presence of IIB neck level metastases in patients with laryngeal carcinoma, to provide valuable evidence to aid surgeons in the decision-making process for neck dissections. As a secondary aim this study analyzed the presence of factors that may be associated with a higher prevalence of metastasis.
Two independent authors (EE, MVV) searched for articles on PubMed, Cochrane, Embase, and Scopus databases. Review of the articles was carried out following 2020 PRISMA guidelines, all articles were assessed for quality according to NICE guidelines. Afterwards the statistical analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias.
A total of 19 studies were included, from which data on 1205 subjects was extracted. Out of 997 patients with a cN0 LC, 21 patients developed metastasis. This meta-analysis found the cumulative rate of metastasis to be 1% (95% CI 0-2%). Also, there is a 51% higher probability (OR: 1.51, 95% CI 0.06, 2.92) of occult IIB metastasis in higher stages (T3/T4) compared to lower stages (T1/T2).
Dissection of level IIB may be safely spared in patients with cN0 laryngeal cancer, possibly leading to improved QoL and shoulder function as well as reducing OR times and costs.
本研究的主要终点是定量评估喉癌患者IIB区颈部淋巴结转移的情况，为外科医生在颈部清扫决策过程中提供有价值的证据。作为次要目的，本研究分析了可能与转移发生率较高相关的因素。
两位独立作者（EE、MVV）在PubMed、Cochrane、Embase和Scopus数据库中检索文章。按照2020年PRISMA指南对文章进行综述，根据英国国家卫生与临床优化研究所（NICE）指南对所有文章进行质量评估。之后使用STATA 18SE软件进行统计分析。还对研究的异质性和发表偏倚风险进行了评估。
共纳入19项研究，从中提取了1205名受试者的数据。在997例cN0期喉癌患者中，有21例发生转移。该荟萃分析发现转移的累积发生率为1%（95%CI 0-2%）。此外，与较低分期（T1/T2）相比，较高分期（T3/T4）患者隐匿性IIB区转移的可能性高51%（OR：1.51，95%CI 0.06，2.92）。
对于cN0期喉癌患者，IIB区清扫可能可以安全省略，这可能会改善生活质量和肩部功能，并减少手术时间和费用。
