title: Outcome after elective neck dissection and observation for the treatment of the clinically node-negative neck (cN0) in squamous cell carcinoma of the oropharynx.
abstract: Optimal elective neck treatment in node-negative (cN0) oropharyngeal squamous cell carcinoma (OPSCC) patients is still controversially discussed. Retrospective chart review of 49 cT1-3 cN0 cM0 OPSCC patients, who had undergone surgical resection of the primary and either elective neck dissection (END) (n = 32) or observation (OBS) (n = 17) of the neck was performed. For systematic review of literature, Pubmed and EMBASE were searched for clinical studies including data on both END and OBS of the neck in cN0 OPSCC patients. Estimated 5-year overall survival (OS) rate was 82 % for END and 76 % for OBS [hazard ratio (HR) = 1.01]. Estimated 5-year disease-free survival (DFS) rate was 78 % for END and 67 % for OBS (HR = 1.79); 5-year DSS rate was 97 % (END) and 81 % (OBS) (HR = 2.22). None of the primary outcome variables (OS, DFS, DSS) revealed statistically significant effects for the treatment assignments. Hazard ratios implied an advantage for END. Systematic review of literature yielded only retrospective chart reviews and no data meeting our selection criteria for further data analysis. Due to lack of high-level evidence, the decision for END in cN0 OPSCC remains a diagnostic and therapeutic challenge. The demonstrated clinical equipoise would provide a solid basis for a multicentric, randomized trial.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Campus Lübeck, University Medical Center Schleswig-Holstein, Universität zu Lübeck, Lübeck, Germany, robert.boescke@uksh.de.
authors: R
authors: R
authors: Böscke
authors: B D
authors: BD
authors: Cakir
authors: A S
authors: AS
authors: Hoffmann
authors: S
authors: S
authors: Wiegand
authors: J
authors: J
authors: Quetz
authors: J E
authors: JE
authors: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D057832:Watchful Waiting
references: Oral Oncol. 2013 Feb;49(2):157-64
references: 22967965
references: Ann Otol Rhinol Laryngol. 1980 Nov-Dec;89(6 Pt 1):551-5
references: 7458145
references: Oral Oncol. 2009 Dec;45(12):1063-6
references: 19717331
references: Laryngoscope. 2005 Apr;115(4):629-39
references: 15805872
references: Laryngoscope. 2008 Dec;118(12):2129-34
references: 18948826
references: Eur Arch Otorhinolaryngol. 1993;250(8):446-9
references: 8129923
references: Laryngoscope. 2005 Feb;115(2):259-63
references: 15689746
references: J Clin Epidemiol. 2009 Oct;62(10):e1-34
references: 19631507
references: Laryngoscope. 2004 Dec;114(12):2228-34
references: 15564851
references: Cancer. 1972 Jun;29(6):1446-9
references: 5031238
references: Oral Oncol. 2006 Feb;42(2):115-22
references: 15979931
references: Head Neck. 2011 Feb;33(2):239-43
references: 20848445
references: Oral Oncol. 2011 May;47(5):320-4
references: 21459661
references: Eur Radiol. 2002 Apr;12(4):727-38
references: 11960218
references: Head Neck. 1990 May-Jun;12(3):197-203
references: 2358329
references: Arch Otolaryngol Head Neck Surg. 2000 Mar;126(3):360-5
references: 10722009
references: Int J Oral Maxillofac Surg. 2007 Mar;36(3):219-25
references: 17239562
references: Laryngoscope. 2006 Jul;116(7):1148-52
references: 16826050
references: J Laryngol Otol. 2002 Nov;116(11):925-8
references: 12487673
references: Laryngoscope. 1997 Oct;107(10):1294-315
references: 9331305
references: Am J Otolaryngol. 2000 Jan-Feb;21(1):31-7
references: 10668674
references: Head Neck. 2004 Nov;26(11):967-71
references: 15459926
references: Br J Oral Maxillofac Surg. 1999 Jun;37(3):175-80
references: 10454023
references: Acta Otolaryngol. 2004 Apr;124(3):231-6
references: 15141748
references: Head Neck Surg. 1985 Nov-Dec;8(2):78-82
references: 4077554
references: Am J Surg. 1990 Oct;160(4):405-9
references: 2221244
references: Lancet. 2007 Oct 20;370(9596):1453-7
references: 18064739
references: J Clin Oncol. 2008 Feb 1;26(4):612-9
references: 18235120
references: Curr Oncol Rep. 2010 Mar;12(2):115-20
references: 20425596
references: Laryngoscope. 2010 Sep;120(9):1788-94
references: 20803740
references: Arch Otolaryngol Head Neck Surg. 1994 Jul;120(7):699-702
references: 8018319
references: Arch Otolaryngol Head Neck Surg. 2008 May;134(5):536-8
references: 18490577
references: Eur Arch Otorhinolaryngol. 2008 Dec;265(12):1535-8
references: 18488240
references: Laryngoscope. 2009 Mar;119(3):534-40
references: 19235752
references: Head Neck Surg. 1988 Jan-Feb;10(3):160-7
references: 3235344
references: Eur Arch Otorhinolaryngol. 2004 May;261(5):276-81
references: 14551793
references: Eur J Surg Oncol. 2009 Mar;35(3):223-9
references: 18468836
references: Int Surg. 1969 Jul;52(1):29-40
references: 5788668
references: Oral Oncol. 2009 Mar;45(3):212-7
references: 18710821
references: Laryngoscope. 2005 Sep;115(9):1672-5
references: 16148715
references: Oral Maxillofac Surg Clin North Am. 2008 Aug;20(3):459-75
references: 18603203
references: Eur Arch Otorhinolaryngol. 2012 Jan;269(1):315-20
references: 21547389
references: Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):751-8
references: 12117328