Management of clinically negative nodes (N0) in supraglottic laryngeal carcinoma: A systematic review

Abstract

ABSTRACT. The purpose of this study was to evaluate the treatment of clinically negative cervical lymph nodes in supraglottic carcinoma by a meta-analysis. The search words were "supraglottic carcinoma", "cervical lymph nodes negative/cN0", "radical neck dissection", and "radiotherapy". The databases included the Chinese biomedical literature database, Medline, Cochrane library, EMBASE database, journals, and theses, etc. from 1989 onwards. Using the 5-year overall survival, disease-free survival, and disease-specific survival rates, and the recurrence and distant metastasis rates as observation indexes, the proper model and method were selected after a heterogeneity test to allow combined statistic tests, sensitivity analysis, and publication bias analysis to be conducted. Four studies (807 cases) were included in the analysis. Comparisons of the 5-year overall survival, diseasefree survival, and disease-specific survival rates as well as lymph node metastasis and the recurrence rate for radical neck dissection and radiotherapy showed no significant differences. There was no advantage of radical neck dissection in supraglottic carcinoma with clinically negative cervical lymph nodes compared to radiotherapy. However, owing to the lack of a prospective study and large number of cases, selection bias and measurement bias may still exist.

Radiotherapy vs surgery for T1‐2N0M0 laryngeal squamous cell carcinoma: A population‐based and propensity score matching study

“…In the current study, surgery yielded better survival than radiotherapy in patients with T1a stage glottis SCC, but not T1b, T1 not specified, or T2 stages. Our analysis showed that there is no statistically significant association between the mode of treatment and survival of early‐stage supra‐ and subglottic SCC, which is consistent with a previous report . The number of patients with T1‐2N0M0 subglottic cancer in our study was limited, perhaps because the vast majority of patients with subglottic cancer present with a locally advanced stage…”

Patterns of Cervical Lymph Node Metastasis in Locally Advanced Supraglottic Squamous Cell Carcinoma: Implications for Neck CTV Delineation

“…The overall metastatic rate of cN0 patients was greater than 20% in pathologic examination (21,22,24), while the LMRs of contralateral levels II to III were relatively low in types A and B groups in our study. IM was detected in levels II and III with LMRs of 21 and 11.1%, respectively, while CM was detected in 6.3 and 4.8%, respectively.…”

“…This result was in accord with the biological behavior of malignancies. Poorly differentiated cells possess a greater capacity to invade lymphatic vascular spaces, which enable tumor cells to enter the bloodstream and lymphatic channels and disseminate widely in the body (24), indicating that poor differentiation should be considered when we design CTV delineation.…”

The survival benefit of lymph node dissection in resected T1–2, cN0 supraglottic cancer: A population‐based propensity score matching analysis

“…5 Regarding the management of cervical lymph nodes in cN0 SC, one research group reported that neck dissection did not improve patients' survival rates but led to overtreatment of 70%-100% of patients and increased the treatmentrelated complications, hospitalization time, and costs. [5][6][7] However, another report suggested that occult metastases may develop into clinical lymph node metastases, and that patients may require a second operation; therefore, selective neck dissection should be performed with surgery. 8 Although most studies showed that lymph node dissection (LND) should be performed in cN0 SC patients, the SC cohorts in these studies constituted stage T1-4, and not exclusively classification T1-2.…”