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Wu K, Dai B, Zhu K, Wu H. The role of unconventional lymph node metastasis in neck recurrence among patients with tongue cancer. Clin Oral Investig 2023; 28:13. [PMID: 38129547 DOI: 10.1007/s00784-023-05421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Statistics on the rate of unconventional lymph node metastases (ULNM) at the time of one-stage radical surgery in tongue cancer patients. To assess whether an extended neck dissection group with additional removal of ULNs has a lower rate of neck recurrence compared to the traditional neck dissection group. MATERIALS AND METHODS A total of 336 patients with TSCC who underwent radical surgery were recruited and underwent traditional or extended neck dissection. Compared to traditional neck dissection, the aim of extended neck dissection is designed to additional resect ULNs. RESULTS In total, 180 patients underwent extended neck dissection, while 156 underwent traditional neck dissection. The incidence of ULNM was 11.67% (21/180) in patients treated with extended neck dissection. The incidence of ipsilateral neck recurrence was 9.49% and 0.56% in patients who underwent traditional and extended neck dissection, respectively (p = 0.0001). CONCLUSIONS Extended neck dissection is effective for preventing neck recurrence in TSCC patients with ULNs. CLINICAL RELEVANCE ULNM may be the main cause of neck recurrence after neck dissection in patients with tongue cancer. A better prognosis may be achieved by additional resection of ULNs on the basis of traditional neck dissection.
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Affiliation(s)
- Kun Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, 410000, China
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, China
| | - Bowen Dai
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, 410000, China
| | - Keke Zhu
- Department of Stomatology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410000, China
| | - Hanjiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, 410000, China.
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Yang J, Liu Q, Bai Y, Zhao H, He T, Zhao Z, Huang M, Jiang M, Zhang R, Zhang M. Prognostic value of lymph node micrometastasis in esophageal cancer: A systematic review and meta-analysis. Front Oncol 2023; 12:1025855. [PMID: 36686727 PMCID: PMC9845692 DOI: 10.3389/fonc.2022.1025855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Objective Whether lymph node micrometastasis (LNM) increases the risk in esophageal cancer patients remains controversial. We conducted a systematic review and meta-analysis to explore the prognosis value of LNM in esophageal cancer patients. Methods Two reviewers independently searched electronic databases, including PubMed, Embase, and the Cochrane Library, for eligible citations until February 2022. We calculated pooled estimates of the hazards ratio with a random-effects model. The certainty of evidence was determined by the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) method. A sensitivity analysis was performed to assess the stability. Publication bias was assessed using funnel plots and Egger's test. We also performed subgroup analysis to explore the source of heterogeneity. Results A total of 16 studies, with 1,652 patients, were included. The overall survival (OS) was significantly increased with LNM negativity compared with LNM positivity (HR 1.95; 95% CI, 1.53-2.49; P < 0.001; I2 = 0.0%, P = 0.930; certainty of evidence: low). Relapse-free survival (RFS) was significantly increased with LNM negativity compared with LNM positivity (HR 3.39; 95% CI, 1.87-6.16; P < 0.001; I2 = 50.18%, P = 0.060; certainty of evidence: moderate). No significant difference was observed in recurrence between the two groups (certainty of evidence: low). Sensitivity analysis revealed a stable trend. In addition, the funnel plot and Egger's test did not show significant publication bias. Conclusion LNM positivity worsens the prognosis in esophageal cancer, and the evidence for RFS is moderate. Future relevant high-quality studies are warranted to validate our results further and provide a reference for guidelines. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier (CRD42022321768).
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Affiliation(s)
- Jing Yang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Qianqian Liu
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Yuping Bai
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,The Department of Pathology, Hainan Provincial Hospital, Haikou, Hainan, China
| | - Haitong Zhao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Tingting He
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Ziru Zhao
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Min Huang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Mengyuan Jiang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Rui Zhang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China
| | - Min Zhang
- School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China,*Correspondence: Min Zhang,
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