The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma

Tsushima, Nobuko; Hayashi, Ryuichi; Shinozaki, Takahiro; Tomioka, Toshifumi; Okano, Wataru; Ikeda, Masakazu

doi:10.1093/jjco/hyz022

Cited by 8 publications

(16 citation statements)

References 9 publications

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“…All the studies were case series, except the case control study by Djordjevic et al [45]. Eight studies were prospective [20,25,27,29,36,39,42,45]; fifteen studies analyzed the larynx without specification of occult metastasis by subsite [10,13,15,20,[24][25][26][27]29,34,37,39,40,43,46]; nineteen analyzed supraglottic tumors [10,12,14,16,18,19,22,23,28,[30][31][32][33]35,36,38,42,44,45]; and six, glottic tumors [10,17,21,23,31,41]. Katilmis et al included a small number of hypopharynx tumors (13/213)…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, the most common clinical and histopathological characteristics of the primary tumor provided by the studies analyzed do not help to elucidate the cause of such heterogeneity. For example, for larynx tumors NOS, Deganello et al [10] reported a low incidence of occult metastasis of 12% while Tsushima et al [46], Xu et al [40] and Candela et al [13] reported incidences higher than 32%. Heterogeneity was also found in supraglottic tumors.…”

Section: Discussionmentioning

confidence: 99%

“…These studies reported a pooled incidence of occult metastasis of 22.9% (95% CI 18.6-25.1, I2 = 58%) ( Figure S1). A subgroup analysis of studies that included >75% of T3-4 tumors [15,25,26,37,40,43,46] was done, and the pooled incidence was 23.4% (95% CI 18.0-28.8, I2 = 44%) ( Figure S3).…”

Section: Glottic Tumorsmentioning

confidence: 99%

“…The presence of occult lymph node metastasis at level I was reported in only two studies [10,13], but in both there was no information about involvement of sublevels IA or IB. Level II involvement was reported in eleven studies [10,13,24,27,29,[32][33][34][44][45][46], level III in eleven studies, [10,13,24,27,29,[32][33][34][44][45][46], level IV in seventeen studies [10,13,20,[24][25][26][27]29,[32][33][34]37,39,[43][44][45][46] and level V in five studies [10,13,20,24,34]. Figures S4, S5 and Table S1 shows data about the studies and pooled incidence and…”

Section: Occult Metastasis By Lymph Node Levelmentioning

confidence: 99%

“…The studies of Candela et al [13] and Djordjevic et al [45] explain the statistical heterogeneity for the level III analysis and the study of Spriano et al [24] explains the statistical heterogeneity for the level V analysis. Fifteen studies assessed larynx tumors without specifying the outcomes by subsite (NOS) [10,13,15,20,[24][25][26][27]29,34,37,39,40,43,46]. Patients had tumors classified as supraglottic in 26.1%, transglottic in 24.8% and glottic/other site in 21.0% of the cases.…”

Section: Occult Metastasis By Lymph Node Levelmentioning

confidence: 99%

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Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

Sanábria

Shah

Medina

et al. 2020

Cancers

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Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Glottic Tumorsmentioning

confidence: 99%

Section: Occult Metastasis By Lymph Node Levelmentioning

confidence: 99%

Section: Occult Metastasis By Lymph Node Levelmentioning

confidence: 99%

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Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

Sanábria

Shah

Medina

et al. 2020

Cancers

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Management of clinically node‐negative glottic squamous cell carcinoma patients according to risk‐scoring model for occult lymph node metastases

Heng

Lin

et al. 2022

Laryngoscope Investig Oto

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Background Glottic squamous cell carcinoma (GSCC) is the most prevalent type of laryngeal carcinoma. The value of prophylactic lymph node dissection (LND) in resected GSCC remains controversial. This study aims to quantitatively assess the probability of occult lymph node metastasis (LNM) for GSCC patients and devise individualized postoperative radiotherapy strategies. Methods A total of 1319 patients with GSCC were retrospectively analyzed. Results GSCC patients with T1‐T2 stages showed significantly lower LNM rate than those with T3‐T4 stages. For patients with T3‐T4 GSCC, multivariate logistic analyses indicated that three factors—maximum tumor diameter (MTD) of more than 2.0 cm, relatively low differentiation, and tumor invasive depth of no less than 1.0 cm—were independent risk factors for the existence of LNM. A predictive nomogram was established based on these factors. The accuracy and validity of our model were verified by 0.716 and remained at 0.717 after 1000 bootstrapping. The calibration curve was also plotted and showed a favorable agreement. The patients were stratified into two groups based on their individual LNM risk points. Possible LNM rates for low‐risk and high‐risk subgroups were 4.7% and 25.2%, respectively. Conclusions A new post‐operative strategy selection flow chart was established based on our newly created nomogram which can effectively predict the individualized possibility of occult LNM for GSCC patients. For clinical T3‐4N0 patients in the high‐risk subgroup, prophylactic dose post‐operative radiation therapy is recommended. However, for all those clinically diagnosed as T1‐2N0 stage, regular follow‐up is sufficient in view of the low occult LNM rate. Level of Evidence: 2a

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The role of central neck dissection and adjuvant treatment in pT4aN0 laryngeal carcinoma treated with open partial horizontal laryngectomy

Bertolin,

Laura,

Cena

et al. 2024

Eur Arch Otorhinolaryngol

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The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma

Cited by 8 publications

References 9 publications

Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

Management of clinically node‐negative glottic squamous cell carcinoma patients according to risk‐scoring model for occult lymph node metastases

The role of central neck dissection and adjuvant treatment in pT4aN0 laryngeal carcinoma treated with open partial horizontal laryngectomy

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