Prevalence of occult nodal metastases in squamous cell carcinoma of the temporal bone: a systematic review and meta-analysis

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Abstract

Purpose

Primary: To determine the rate of occult cervical metastases in primary temporal bone squamous cell carcinomas (TBSSC). Secondary: to perform a subgroup meta-analysis of the risk of occult metastases based on the clinical stage of the tumour and its risk based on corresponding levels of the neck.

Methods

A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to November 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle–Ottawa scale.

Results

Overall, 13 out of 3301 screened studies met the inclusion criteria, for a total of 1120 patients of which 550 had TBSCC. Out of the 267 patients who underwent a neck dissection, 33 had positive lymph nodes giving a pooled rate of occult metastases of 14% (95% CI 10–19%). Occult metastases rate varied according to Modified Pittsburg staging system, being 0% (0–16%) among 12 pT1, 7% (2–20%) among 43 pT2 cases, 21% (11–38%) among 45 pT3, and 18% (11–27%) among 102 pT4 cases. Data available showed that most of the positive nodes were in Level II.

Conclusion

The rate of occult cervical metastases in TBSCC increases with pathological T category with majority of nodal disease found in level II of the neck.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00405-022-07399-3.

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

David Moher, Larissa Shamseer, Mike Clarke … (2017)

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

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Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.

J. A. Sterne, M. Egger (2001)

Asymmetry in funnel plots may indicate publication bias in meta-analysis, but the shape of the plot in the absence of bias depends on the choice of axes. We evaluated standard error, precision (inverse of standard error), variance, inverse of variance, sample size and log sample size (vertical axis) and log odds ratio, log risk ratio and risk difference (horizontal axis). Standard error is likely to be the best choice for the vertical axis: the expected shape in the absence of bias corresponds to a symmetrical funnel, straight lines to indicate 95% confidence intervals can be included and the plot emphasises smaller studies which are more prone to bias. Precision or inverse of variance is useful when comparing meta-analyses of small trials with subsequent large trials. The use of sample size or log sample size is problematic because the expected shape of the plot in the absence of bias is unpredictable. We found similar evidence for asymmetry and between trial variation in a sample of 78 published meta-analyses whether odds ratios or risk ratios were used on the horizontal axis. Different conclusions were reached for risk differences and this was related to increased between-trial variation. We conclude that funnel plots of meta-analyses should generally use standard error as the measure of study size and ratio measures of treatment effect.

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Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

David Pfister, Sharon Spencer, David L. Adelstein … (2020)

Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.

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Author and article information

Contributors

Daniele Borsetto:

ORCID: http://orcid.org/0000-0003-3464-2688

db847@cam.ac.uk

Journal

Journal ID (nlm-ta): Eur Arch Otorhinolaryngol

Journal ID (iso-abbrev): Eur Arch Otorhinolaryngol

Title: European Archives of Oto-Rhino-Laryngology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0937-4477

ISSN (Electronic): 1434-4726

Publication date (Electronic): 13 May 2022

Publication date PMC-release: 13 May 2022

Publication date (Print): 2022

Volume: 279

Issue: 12

Pages: 5573-5581

Affiliations

[1 ]GRID grid.24029.3d, ISNI 0000 0004 0383 8386, Department of ENT, Addenbrookes Hospital, , Cambridge University Hospitals NHS Foundation Trust, ; Cambridge, UK

[2 ]GRID grid.5335.0, ISNI 0000000121885934, University of Cambridge, ; Cambridge, UK

[3 ]GRID grid.439624.e, ISNI 0000 0004 0467 7828, Department of ENT, Lister Hospital, , East and North Herts NHS Trust, ; Stevenage, UK

[4 ]GRID grid.418321.d, ISNI 0000 0004 1757 9741, Department of Radiation Oncology, , Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, ; Aviano, Italy

[5 ]GRID grid.411299.6, Department of Otolaryngology, Head and Neck Surgery, , University Hospital of Larissa, ; 41110 Larissa, Greece

[6 ]GRID grid.418321.d, ISNI 0000 0004 1757 9741, Unit of Cancer Epidemiology, , Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, ; Aviano, Italy

[7 ]GRID grid.5133.4, ISNI 0000 0001 1941 4308, Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, , University of Trieste, ; Trieste, Italy

Author information

Daniele Borsetto http://orcid.org/0000-0003-3464-2688

Article

Publisher ID: 7399

DOI: 10.1007/s00405-022-07399-3

PMC ID: 9649468

PubMed ID: 35562514

SO-VID: 6a582294-b104-4c9a-821e-bde086b4447b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 13 January 2022

Date accepted : 7 April 2022

Custom metadata

ScienceOpen disciplines: Otolaryngology

Keywords: lymph node metastases,squamous cell carcinoma,elective neck dissection,meta-analysis,temporal bone carcinoma

Data availability:

ScienceOpen disciplines: Otolaryngology

Keywords: lymph node metastases, squamous cell carcinoma, elective neck dissection, meta-analysis, temporal bone carcinoma

Prevalence of occult nodal metastases in squamous cell carcinoma of the temporal bone: a systematic review and meta-analysis

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Most cited references 34

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.

Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

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