Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research
•Management of node-negative neck in early-stage oral cancer has been debatable.•Nearly 20-30% of such patients harbour occult metastases in draining lymph nodes.•The N0 neck is usually addressed with elective neck dissection or watchful waiting.•Sentinel lymph node biopsy is an intermediate approac...
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| Veröffentlicht in: | Oral oncology 2022-01, Vol.124, p.105642-105642, Article 105642 |
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| creator | Gupta, Tejpal Maheshwari, Guncha Kannan, Sadhana Nair, Sudhir Chaturvedi, Pankaj Agarwal, Jai Prakash |
| description | •Management of node-negative neck in early-stage oral cancer has been debatable.•Nearly 20-30% of such patients harbour occult metastases in draining lymph nodes.•The N0 neck is usually addressed with elective neck dissection or watchful waiting.•Sentinel lymph node biopsy is an intermediate approach between these two strategies.•Sentinel node biopsy is oncologically non-inferior to elective neck dissection.
Management of clinically node-negative (N0) neck in early-stage (T1-T2) oral and/or oropharyngeal squamous cell carcinoma (OOSCC) has been controversial. The purpose of this systematic review and meta-analysis was to compare sentinel lymph node biopsy (SLNB) with elective neck dissection (END) in early-stage OOSCC.
Studies comparing SLNB versus END in early-stage clinically node-negative OOSCC were identified using validated search strategy. To be considered eligible, trials had to include patients with early-stage, clinically node-negative OOSCC who had been randomly assigned to either SLNB or END. Primary outcome of interest was overall survival (OS), while secondary outcomes included isolated neck nodal recurrence (NNR), loco-regional recurrence (LRR), and neck-shoulder function. Outcome data was pooled using random-effects model and reported as hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Any p-value |
| doi_str_mv | 10.1016/j.oraloncology.2021.105642 |
| format | Article |
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Management of clinically node-negative (N0) neck in early-stage (T1-T2) oral and/or oropharyngeal squamous cell carcinoma (OOSCC) has been controversial. The purpose of this systematic review and meta-analysis was to compare sentinel lymph node biopsy (SLNB) with elective neck dissection (END) in early-stage OOSCC.
Studies comparing SLNB versus END in early-stage clinically node-negative OOSCC were identified using validated search strategy. To be considered eligible, trials had to include patients with early-stage, clinically node-negative OOSCC who had been randomly assigned to either SLNB or END. Primary outcome of interest was overall survival (OS), while secondary outcomes included isolated neck nodal recurrence (NNR), loco-regional recurrence (LRR), and neck-shoulder function. Outcome data was pooled using random-effects model and reported as hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Any p-value < 0.05 was considered statistically significant.
A total of 608 patients from three trials comparing SLNB versus END in early-stage clinically node-negative OOSCC were included. The pooled HR of death for SLNB versus END was 1.18 (95% CI: 0.79–1.78, p = 0.41) which was not statistically significant. The rates of isolated NNR (pooled RR = 1.11, 95% CI: 0.69–1.80, p = 0.66) and LRR (pooled RR = 1.18, 95% CI: 0.81–1.72, p = 0.39) were also similar. Pooled analysis of the neck-shoulder function significantly favoured SLNB arm (pooled RR = 1.21, 95% CI: 1.12–1.32, p < 0.00001).
There is low-certainty evidence that SLNB is oncologically non-inferior to END and is associated with potentially lesser functional morbidity making it an emerging alternative standard of care in patients with early-stage clinically node-negative OOSCC.</description><identifier>ISSN: 1368-8375</identifier><identifier>EISSN: 1879-0593</identifier><identifier>DOI: 10.1016/j.oraloncology.2021.105642</identifier><identifier>PMID: 34861565</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Carcinoma, Squamous Cell - pathology ; Head and Neck Neoplasms ; Humans ; Mouth Neoplasms - pathology ; Mouth Neoplasms - surgery ; Neck Dissection ; Observation ; Oral cancer ; Randomized Controlled Trials as Topic ; Sentinel Lymph Node Biopsy ; Sentinel node ; Squamous Cell Carcinoma of Head and Neck - surgery ; Survival</subject><ispartof>Oral oncology, 2022-01, Vol.124, p.105642-105642, Article 105642</ispartof><rights>2021 Elsevier Ltd</rights><rights>Copyright © 2021 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-ecdc6a0450dd7754ab7e797d02b21133ab654a9bce34c3e7cbe1b328b7b311d03</citedby><cites>FETCH-LOGICAL-c446t-ecdc6a0450dd7754ab7e797d02b21133ab654a9bce34c3e7cbe1b328b7b311d03</cites><orcidid>0000-0001-8485-1504</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.oraloncology.2021.105642$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34861565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Tejpal</creatorcontrib><creatorcontrib>Maheshwari, Guncha</creatorcontrib><creatorcontrib>Kannan, Sadhana</creatorcontrib><creatorcontrib>Nair, Sudhir</creatorcontrib><creatorcontrib>Chaturvedi, Pankaj</creatorcontrib><creatorcontrib>Agarwal, Jai Prakash</creatorcontrib><title>Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research</title><title>Oral oncology</title><addtitle>Oral Oncol</addtitle><description>•Management of node-negative neck in early-stage oral cancer has been debatable.•Nearly 20-30% of such patients harbour occult metastases in draining lymph nodes.•The N0 neck is usually addressed with elective neck dissection or watchful waiting.•Sentinel lymph node biopsy is an intermediate approach between these two strategies.•Sentinel node biopsy is oncologically non-inferior to elective neck dissection.
Management of clinically node-negative (N0) neck in early-stage (T1-T2) oral and/or oropharyngeal squamous cell carcinoma (OOSCC) has been controversial. The purpose of this systematic review and meta-analysis was to compare sentinel lymph node biopsy (SLNB) with elective neck dissection (END) in early-stage OOSCC.
Studies comparing SLNB versus END in early-stage clinically node-negative OOSCC were identified using validated search strategy. To be considered eligible, trials had to include patients with early-stage, clinically node-negative OOSCC who had been randomly assigned to either SLNB or END. Primary outcome of interest was overall survival (OS), while secondary outcomes included isolated neck nodal recurrence (NNR), loco-regional recurrence (LRR), and neck-shoulder function. Outcome data was pooled using random-effects model and reported as hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Any p-value < 0.05 was considered statistically significant.
A total of 608 patients from three trials comparing SLNB versus END in early-stage clinically node-negative OOSCC were included. The pooled HR of death for SLNB versus END was 1.18 (95% CI: 0.79–1.78, p = 0.41) which was not statistically significant. The rates of isolated NNR (pooled RR = 1.11, 95% CI: 0.69–1.80, p = 0.66) and LRR (pooled RR = 1.18, 95% CI: 0.81–1.72, p = 0.39) were also similar. Pooled analysis of the neck-shoulder function significantly favoured SLNB arm (pooled RR = 1.21, 95% CI: 1.12–1.32, p < 0.00001).
There is low-certainty evidence that SLNB is oncologically non-inferior to END and is associated with potentially lesser functional morbidity making it an emerging alternative standard of care in patients with early-stage clinically node-negative OOSCC.</description><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Head and Neck Neoplasms</subject><subject>Humans</subject><subject>Mouth Neoplasms - pathology</subject><subject>Mouth Neoplasms - surgery</subject><subject>Neck Dissection</subject><subject>Observation</subject><subject>Oral cancer</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Sentinel node</subject><subject>Squamous Cell Carcinoma of Head and Neck - surgery</subject><subject>Survival</subject><issn>1368-8375</issn><issn>1879-0593</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUsmO1DAQDQjEDA1_gJDFiUt67DhLZ25oGBZpJA7A2fJSnXbjJeNKNwpfj9M9II6cXH61vqpXFG8YXTPK2qv9OibpYtDRxWFeV7Ri2dG0dfW4uGSbri9p0_Mn2ebtptzwrrkoniPuKaUNa-iz4oLXm5Y1bXP56NXXGSfwcrKaJDha-ElkMMTDJEsZpJvRIolbkjIavf0FhugYphSdy-aUrHSYET_KZMNAwIGe7BFIAP2DGIu4_GMgR0h4QIIQJhvAETf7cUdCNECUjSPOxAYCMrm5xEkOQLSzwWrp3HyKKgMM8lR54b7MeBVTtuO4k2kOA2QQ7w_Sx9xFg3NEy6RtiF5ek9ujNRA0lEoikG1OHJPMc2k4kbV-dLnVMieevAkwj6J3L4qn28wPXj68q-L7h9tvN5_Kuy8fP9-8uyt1XbdTCdroVtK6ocZ0XVNL1UHXd4ZWqmKMc6naDPZKA681h04rYIpXG9UpzpihfFW8PdcdU7w_AE7CW1xIyACZj6ha2vas7_NVV8X1OVSniJhgK8ZkfV6BYFQs6hB78a86xKIOcVZHTn790OegPJi_qX_kkAPenwMgs81iSAK1XTZnbMqHFCba_-nzG6ea3MQ</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Gupta, Tejpal</creator><creator>Maheshwari, Guncha</creator><creator>Kannan, Sadhana</creator><creator>Nair, Sudhir</creator><creator>Chaturvedi, Pankaj</creator><creator>Agarwal, Jai Prakash</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8485-1504</orcidid></search><sort><creationdate>202201</creationdate><title>Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research</title><author>Gupta, Tejpal ; Maheshwari, Guncha ; Kannan, Sadhana ; Nair, Sudhir ; Chaturvedi, Pankaj ; Agarwal, Jai Prakash</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-ecdc6a0450dd7754ab7e797d02b21133ab654a9bce34c3e7cbe1b328b7b311d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Head and Neck Neoplasms</topic><topic>Humans</topic><topic>Mouth Neoplasms - pathology</topic><topic>Mouth Neoplasms - surgery</topic><topic>Neck Dissection</topic><topic>Observation</topic><topic>Oral cancer</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Sentinel node</topic><topic>Squamous Cell Carcinoma of Head and Neck - surgery</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Tejpal</creatorcontrib><creatorcontrib>Maheshwari, Guncha</creatorcontrib><creatorcontrib>Kannan, Sadhana</creatorcontrib><creatorcontrib>Nair, Sudhir</creatorcontrib><creatorcontrib>Chaturvedi, Pankaj</creatorcontrib><creatorcontrib>Agarwal, Jai Prakash</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Oral oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Tejpal</au><au>Maheshwari, Guncha</au><au>Kannan, Sadhana</au><au>Nair, Sudhir</au><au>Chaturvedi, Pankaj</au><au>Agarwal, Jai Prakash</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research</atitle><jtitle>Oral oncology</jtitle><addtitle>Oral Oncol</addtitle><date>2022-01</date><risdate>2022</risdate><volume>124</volume><spage>105642</spage><epage>105642</epage><pages>105642-105642</pages><artnum>105642</artnum><issn>1368-8375</issn><eissn>1879-0593</eissn><abstract>•Management of node-negative neck in early-stage oral cancer has been debatable.•Nearly 20-30% of such patients harbour occult metastases in draining lymph nodes.•The N0 neck is usually addressed with elective neck dissection or watchful waiting.•Sentinel lymph node biopsy is an intermediate approach between these two strategies.•Sentinel node biopsy is oncologically non-inferior to elective neck dissection.
Management of clinically node-negative (N0) neck in early-stage (T1-T2) oral and/or oropharyngeal squamous cell carcinoma (OOSCC) has been controversial. The purpose of this systematic review and meta-analysis was to compare sentinel lymph node biopsy (SLNB) with elective neck dissection (END) in early-stage OOSCC.
Studies comparing SLNB versus END in early-stage clinically node-negative OOSCC were identified using validated search strategy. To be considered eligible, trials had to include patients with early-stage, clinically node-negative OOSCC who had been randomly assigned to either SLNB or END. Primary outcome of interest was overall survival (OS), while secondary outcomes included isolated neck nodal recurrence (NNR), loco-regional recurrence (LRR), and neck-shoulder function. Outcome data was pooled using random-effects model and reported as hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Any p-value < 0.05 was considered statistically significant.
A total of 608 patients from three trials comparing SLNB versus END in early-stage clinically node-negative OOSCC were included. The pooled HR of death for SLNB versus END was 1.18 (95% CI: 0.79–1.78, p = 0.41) which was not statistically significant. The rates of isolated NNR (pooled RR = 1.11, 95% CI: 0.69–1.80, p = 0.66) and LRR (pooled RR = 1.18, 95% CI: 0.81–1.72, p = 0.39) were also similar. Pooled analysis of the neck-shoulder function significantly favoured SLNB arm (pooled RR = 1.21, 95% CI: 1.12–1.32, p < 0.00001).
There is low-certainty evidence that SLNB is oncologically non-inferior to END and is associated with potentially lesser functional morbidity making it an emerging alternative standard of care in patients with early-stage clinically node-negative OOSCC.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34861565</pmid><doi>10.1016/j.oraloncology.2021.105642</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-8485-1504</orcidid></addata></record> |
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| identifier | ISSN: 1368-8375 |
| ispartof | Oral oncology, 2022-01, Vol.124, p.105642-105642, Article 105642 |
| issn | 1368-8375 1879-0593 |
| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Carcinoma, Squamous Cell - pathology Head and Neck Neoplasms Humans Mouth Neoplasms - pathology Mouth Neoplasms - surgery Neck Dissection Observation Oral cancer Randomized Controlled Trials as Topic Sentinel Lymph Node Biopsy Sentinel node Squamous Cell Carcinoma of Head and Neck - surgery Survival |
| title | Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research |
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