Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma

Clemente Chia; Seraphina Key; Zubair Hasan; Sohaib Virk; Faruque Riffat

doi:10.1002/cnr2.1410

Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma

Cancer Rep (Hoboken). 2021 Dec;4(6):e1410. doi: 10.1002/cnr2.1410. Epub 2021 May 8.

Authors

Clemente Chia¹, Seraphina Key², Zubair Hasan^{1

3

4}, Sohaib Virk⁵, Faruque Riffat^{4

6

7}

Affiliations

¹ Monash Health, Clayton, Victoria, Australia.
² Monash University, Clayton, Victoria, Australia.
³ Westmead Hospital, Westmead, New South Wales, Australia.
⁴ University of Sydney, Camperdown, New South Wales, Australia.
⁵ University of New South Wales, Randwick, New South Wales, Australia.
⁶ Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
⁷ Macquarie University Hospital, Macquarie University, Macquarie Park, New South Wales, Australia.

Abstract

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.

Aim: 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.

Methods and 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).

Conclusion: 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.

Keywords: alveolar process; carcinoma; hard; lymphatic metastasis; neck dissection; palate; squamous cell.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Animals
Head and Neck Neoplasms / secondary*
Humans
Lymphatic Metastasis
Maxillary Neoplasms / pathology*
Mouth Neoplasms / pathology*
Squamous Cell Carcinoma of Head and Neck / pathology*