Elective node dissection versus observation for management of patients with early-stage cT1/T2N0 tongue carcinoma: A systematic review and meta-analysis of prospective studies

Abstract

Objective: To carry out a meta-analysis of prospective literature comparing the clinical efficacy of elective neck dissection (END) vs observation (OBS) in patients with early-stage cT1/T2N0 tongue carcinoma. Design/Setting/Participants/Outcome Measures: We systematically reviewed four databases from inception to 30-October-2020. We considered all studies meeting the following PICOS conditions: (a) Patients: early-stage cT1/T2N0 tongue carcinoma, (b) Intervention: END, (c) Comparator: OBS, (d) Outcomes: local tongue recurrence, cervical nodal recurrence, disease-specific survival (DSS) rate, and disease-free survival (DFS) rate and (e) Study design: prospective reports. We pooled dichotomous data as relative risks (RRs) with 95% confidence intervals (CIs). Results: Four studies (one case-control study and three randomised controlled trials) met our inclusion criteria. There were 448 eligible patients (225 and 223 patients were treated with END and OBS, respectively). END significantly correlated with improved DSS rate (RR = 1.15, 95% CI: 1.04-1.27, P =.007). Nonetheless, there were no significant differences between END and OBS groups regarding the rates of local tongue recurrence (RR = 1.23, 95% CI: 0.50-3.03, P =.65), cervical nodal recurrence (RR = 0.45, 95% CI: 0.16-1.27, P =.13) and DFS rate (RR = 1.08, 95% CI: 0.91-1.27, P =.38). Pooled analysis for cervical nodal recurrence was heterogeneous, and sensitivity analysis revealed a significantly lower cervical nodal recurrence rate in favour of END group (RR = 0.30, 95% CI: 0.13-0.67, P =.004). Conclusion: END correlated with a significant decrease in cervical nodal recurrence and improved DSS rate. END might be superior to OBS in patients with early-stage cT1/T2N0 tongue cancer.