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Abstract：
UNASSIGNED: Lymph node metastasis (LNM) is the most significant parameter affecting overall survival in patients with oral cavity squamous cell carcinomas (OCSCC). Elective neck dissection (END) is the standard of care in the early management of OCSCC with a depth of invasion (DOI) greater than 2-4 mm. However, most patients show no LNM in the final pathologic report, indicating overtreatment. Thus, more detailed indicators are needed to predict LNM in patients with OCSCC. In this study, we critically evaluate the existing literature about the risk of different histological parameters in estimating LNM.
UNASSIGNED: A systematic review was conducted using PRISMA guidelines. PubMed, Web of Science, Cochrane, and Scopus were searched from inception to December 2023 to collect all relevant studies. Eligibility screening of records was performed, and data extraction from the selected studies was carried out independently. Inclusion in our systematic review necessitated the following prerequisites: Involvement of patients diagnosed with OCSCC, and examination of histological parameters related to lymph node metastasis in these studies. Exclusion criteria included animal studies, non-English articles, non-availability of full text, and unpublished data.
UNASSIGNED: We included 217 studies in our systematic review, of which 142 were eligible for the meta-analysis. DOI exceeding 4 mm exhibited higher risk for LNM [Risk ratio (RR) 2.18 (1.91-2.48), p<0.00001], as did perineural invasion (PNI) [RR 2.04 (1.77-2.34), p<0.00001], poorly differentiated tumors [RR 1.97 (1.61-2.42), p<0.00001], lymphovascular invasion (LVI) [RR 2.43 (2.12-2.78), p<0.00001], groups and single pattern of invasion [RR 2.47 (2.11-2.89), p<0.00001], high tumor budding [RR 2.65 (1.99-3.52), p<0.00001], tumor size over 4 cm [RR 1.76 (1.43-2.18), p<0.00001], tumor thickness beyond 4 mm [RR 2.72 (1.91-3.87), p<0.00001], involved or close margin [RR 1.73 (1.29-2.33), p = 0.0003], and T3 and T4 disease [RR 1.98 (1.62-2.41), p <0.00001].
UNASSIGNED: Our results confirm the potential usefulness of many histopathological features in predicting LNM and highlight the promising results of others. Many of these parameters are not routinely incorporated into pathologic reports. Future studies must focus on applying these parameters to examine their validity in predicting the need for elective neck treatment.
UNASSIGNED: A systematic review was conducted using PRISMA guidelines. PubMed, Web of Science, Cochrane, and Scopus were searched from inception to December 2023 to collect all relevant studies. Eligibility screening of records was performed, and data extraction from the selected studies was carried out independently. Inclusion in our systematic review necessitated the following prerequisites: Involvement of patients diagnosed with OCSCC, and examination of histological parameters related to lymph node metastasis in these studies. Exclusion criteria included animal studies, non-English articles, non-availability of full text, and unpublished data.
UNASSIGNED: We included 217 studies in our systematic review, of which 142 were eligible for the meta-analysis. DOI exceeding 4 mm exhibited higher risk for LNM [Risk ratio (RR) 2.18 (1.91-2.48), p<0.00001], as did perineural invasion (PNI) [RR 2.04 (1.77-2.34), p<0.00001], poorly differentiated tumors [RR 1.97 (1.61-2.42), p<0.00001], lymphovascular invasion (LVI) [RR 2.43 (2.12-2.78), p<0.00001], groups and single pattern of invasion [RR 2.47 (2.11-2.89), p<0.00001], high tumor budding [RR 2.65 (1.99-3.52), p<0.00001], tumor size over 4 cm [RR 1.76 (1.43-2.18), p<0.00001], tumor thickness beyond 4 mm [RR 2.72 (1.91-3.87), p<0.00001], involved or close margin [RR 1.73 (1.29-2.33), p = 0.0003], and T3 and T4 disease [RR 1.98 (1.62-2.41), p <0.00001].
UNASSIGNED: Our results confirm the potential usefulness of many histopathological features in predicting LNM and highlight the promising results of others. Many of these parameters are not routinely incorporated into pathologic reports. Future studies must focus on applying these parameters to examine their validity in predicting the need for elective neck treatment.
摘要：
■淋巴结转移（LNM）是影响口腔鳞状细胞癌（OCSCC）患者总生存期的最重要参数。选择性颈淋巴结清扫术（END）是早期治疗OCSCC的标准护理，其侵袭深度（DOI）大于2-4mm。然而,大多数患者在最终病理报告中没有显示LNM，表明过度治疗。因此，需要更详细的指标来预测OCSCC患者的LNM。在这项研究中,我们严格评估现有文献中关于不同组织学参数在估计LNM中的风险。
■使用PRISMA指南进行了系统评价。PubMed,WebofScience,科克伦,和Scopus从开始到2023年12月进行了搜索，以收集所有相关研究。对记录进行了资格筛选，并且从所选研究中独立进行数据提取。纳入我们的系统评价需要以下先决条件：参与诊断为OCSCC的患者，并在这些研究中检查与淋巴结转移相关的组织学参数。排除标准包括动物研究，非英语文章,全文不可用，和未公布的数据。
■我们在系统评价中纳入了217项研究，其中142人符合荟萃分析的条件.DOI超过4mm表现出更高的LNM风险[风险比（RR）2.18（1.91-2.48），p<0.00001],神经周浸润（PNI）[RR2.04（1.77-2.34），p<0.00001],低分化肿瘤[RR1.97（1.61-2.42），p<0.00001],淋巴管浸润（LVI）[RR2.43（2.12-2.78），p<0.00001],群体和单一入侵模式[RR2.47(2.11-2.89)，p<0.00001],高肿瘤出芽[RR2.65（1.99-3.52），p<0.00001],肿瘤大小超过4厘米[RR1.76（1.43-2.18），p<0.00001],肿瘤厚度超过4毫米[RR2.72（1.91-3.87），p<0.00001],涉及或接近保证金[RR1.73（1.29-2.33），p=0.0003],和T3和T4疾病[RR1.98（1.62-2.41），p<0.00001]。
■我们的结果证实了许多组织病理学特征在预测LNM方面的潜在有用性，并突出了其他有希望的结果。这些参数中的许多参数并未常规纳入病理报告中。未来的研究必须集中在应用这些参数来检查其在预测选择性颈部治疗需求方面的有效性。
■使用PRISMA指南进行了系统评价。PubMed,WebofScience,科克伦,和Scopus从开始到2023年12月进行了搜索，以收集所有相关研究。对记录进行了资格筛选，并且从所选研究中独立进行数据提取。纳入我们的系统评价需要以下先决条件：参与诊断为OCSCC的患者，并在这些研究中检查与淋巴结转移相关的组织学参数。排除标准包括动物研究，非英语文章,全文不可用，和未公布的数据。
■我们在系统评价中纳入了217项研究，其中142人符合荟萃分析的条件.DOI超过4mm表现出更高的LNM风险[风险比（RR）2.18（1.91-2.48），p<0.00001],神经周浸润（PNI）[RR2.04（1.77-2.34），p<0.00001],低分化肿瘤[RR1.97（1.61-2.42），p<0.00001],淋巴管浸润（LVI）[RR2.43（2.12-2.78），p<0.00001],群体和单一入侵模式[RR2.47(2.11-2.89)，p<0.00001],高肿瘤出芽[RR2.65（1.99-3.52），p<0.00001],肿瘤大小超过4厘米[RR1.76（1.43-2.18），p<0.00001],肿瘤厚度超过4毫米[RR2.72（1.91-3.87），p<0.00001],涉及或接近保证金[RR1.73（1.29-2.33），p=0.0003],和T3和T4疾病[RR1.98（1.62-2.41），p<0.00001]。
■我们的结果证实了许多组织病理学特征在预测LNM方面的潜在有用性，并突出了其他有希望的结果。这些参数中的许多参数并未常规纳入病理报告中。未来的研究必须集中在应用这些参数来检查其在预测选择性颈部治疗需求方面的有效性。
