背景:口腔上颌鳞状细胞癌(SCC)淋巴结阴性颈部的管理,包括口腔的硬腭和上牙槽亚位点,是有争议的,没有明确的国际共识或建议在没有宫颈转移的情况下进行选择性颈淋巴结清扫术。
目的:评估临床淋巴结阴性的口腔上颌SCC患者的隐匿性转移率;两者作为总转移率,以及在索引手术中接受选择性颈清扫术的患者的比较,与颈部的临床观察相比,原发性切除。
结果:由两名独立研究者对口腔上颌SCC相关研究进行系统评价,并根据PRISMA标准进行分析。数据是从Pubmed中提取的,OvidMEDLINE,EMBASE,和SCOPUS通过相关的MeSH条款。通过GoogleScholar和OpenGrey搜索灰色文献。在最初的搜索中确定了五十三篇文章,根据资格标准对483篇独特文章进行了筛选,并确定了29项研究用于最终数据提取。临床淋巴结阴性的口腔上颌SCC患者的隐匿性转移的发生率在初次选择性颈淋巴结清扫术或常规随访中被确定。进行Meta分析。在初步搜索中确定的553篇相关文章中,29个用于分析。最初出现临床淋巴结阴性疾病的患者隐匿性转移的合并总发生率为22.2%。本研究显示END对降低区域复发具有统计学意义(RR0.36,95%CI0.24,0.59)。
结论:本系统评价和荟萃分析的结果表明,对于表现为硬腭或上肺泡SCC的患者,选择性颈清扫术,即使在临床淋巴结阴性的颈部。
BACKGROUND: Management of the node-negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the
hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases.
OBJECTIVE: To assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck.
RESULTS: A systematic
review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty-three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta-analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node-negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59).
CONCLUSIONS: The results of this systematic
review and meta-analysis suggest elective neck dissection for patients presenting with
hard palate or upper alveolar SCC, even in a clinically node negative neck.