Elective Neck Dissection Versus Wait-and-Watch Policy for Oral Cavity Squamous Cell Carcinoma in Early Stage: A Systematic Review and Meta-Analysis Based on Survival Data
| Autor: | Xia Guo, Yubin Cao, Chunjie Li, Longjiang Li, Changhao Yu, Tao Wang |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Oral Cavity Squamous Cell Carcinoma Stage (cooking) Neoplasm Staging Retrospective Studies business.industry Hazard ratio Neck dissection Retrospective cohort study 030206 dentistry Confidence interval Otorhinolaryngology Elective Surgical Procedures Head and Neck Neoplasms 030220 oncology & carcinogenesis Meta-analysis Carcinoma Squamous Cell Neck Dissection Surgery Neoplasm Recurrence Local Oral Surgery Elective Surgical Procedure business |
| Zdroj: | Journal of Oral and Maxillofacial Surgery. 77:2154-2167 |
| ISSN: | 0278-2391 |
| Popis: | Whether elective neck dissection (END) should be adopted for patients with clinically early-stage (cT1-2N0M0) oral cavity squamous cell carcinoma (OCSCC) remains debated. The aim of this systematic review was to compare the survival benefit of END with that of the wait-and-watch policy (WW) for patients with early-stage OCSCC based on survival data.According to the inclusion criteria, an exhaustive search for eligible studies was conducted. The study inclusion and data extraction were performed by 2 reviewers independently. The risk of bias was assessed in duplicate using the Risk Of Bias In Nonrandomized Studies of Interventions instrument. The hazard ratio (HR) of the time-to-event data was extracted or estimated. RevMan 5.3 and STATA 15.1 were adopted for data synthesis.Of the 35 studies that were included, only 5 were assessed as having a low risk of bias. Results of the meta-analyses showed END could significantly decrease neck recurrence (relative risk = 0.45; confidence interval [CI], 0.35-0.59; P .00001) and improve disease-free survival (HR = 0.55; CI, 0.42-0.71; P .00001), overall survival (HR = 0.75; CI, 0.64-0.86; P .0001), and disease-specific survival (HR = 0.76; CI, 0.61-0.94; P = .01) compared with WW for patients with cT1-2N0. The subgroup analysis showed that END could decrease neck recurrence (P .00001) and improve disease-free survival (P = .001) for patients with early-stage tongue cancer and that supraomohyoid neck dissection could decrease neck recurrence (P = .02). For patients with cT1N0, END could significantly decrease the proportion with neck recurrence (P = .0008) and improve disease-free survival (P = .0003), but the difference between overall survival and disease-specific survival did not achieve significance.END can decrease recurrence and improve survival time for patients with early-stage OCSCC. More high-quality studies are needed to make a solid conclusion, especially for patients with cT1N0M0. |
| Databáze: | OpenAIRE |
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