Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Jun 1;145(6):542-548.
doi: 10.1001/jamaoto.2019.0784.

Assessment of the Rate of Skip Metastasis to Neck Level IV in Patients With Clinically Node-Negative Neck Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-analysis

Anton Warshavsky  1 , Roni Rosen  1 , Narin Nard-Carmel  1 , Sara Abu-Ghanem  1 , Yael Oestreicher-Kedem  1 , Avraham Abergel  1 , Dan M Fliss  1 , Gilad Horowitz  1
Affiliations
Meta-Analysis

Assessment of the Rate of Skip Metastasis to Neck Level IV in Patients With Clinically Node-Negative Neck Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-analysis

Anton Warshavsky et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: The rate of skip metastasis to neck level IV in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC) remains controversial.

Objective: To provide a high level of evidence using a meta-analysis on the rate of skip metastasis to level IV in this subset of patients.

Data sources: The Embase, PubMed, and Google Scholar databases were searched for articles published during the period of January 1, 1970, through December 31, 2017, using the following key terms: neck dissection, N0 neck, squamous cell carcinoma, skip metastasis, radical neck dissection, lymph node management, neck metastasis, oral cavity cancer, and tongue cancer. Some terms were also used in combination, and the reference section of each article was searched for additional potentially relevant publications. Data were analyzed from January 8 through 11, 2018.

Study selection: Inclusion criteria were all cohorts, including from any randomized clinical trial, case-control study, case study, and case report; studies of patients with the histopathologic diagnosis of OCSCC; and studies that differentiated data between skip metastasis and sequential metastasis to neck level IV. Of the 115 articles retrieved from the literature, 11 retrospective studies and 2 prospective randomized clinical trials (n = 1359 patients) were included.

Data extraction and synthesis: Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Fixed-effects model and 95% CIs were estimated, and data of included studies were pooled using a fixed-effects model.

Main outcomes and measures: Overall proportion of neck involvement and the rate of level IV skip metastasis. Subgroup analysis for primary site and tumor staging.

Results: The rate of level IV involvement in patients with cN0 ranged between 0% and 11.40% with a fixed-effects model of 2.53% (95% CI, 1.64%-3.55%). The rate of skip metastasis ranged from 0% to 5.50% with a fixed-effects model of 0.50% (95% CI, 0.09%-1.11%). The rate of level IV skip metastasis did not increase significantly in cases that involved neck levels I through III. Tumor staging and primary site tumor did not significantly affect the rate of skip metastasis.

Conclusions and relevance: This meta-analysis showed very low rates of skip metastasis to neck level IV in patients diagnosed with cN0 OCSCC. Encountering an allegedly positive lymph node during neck dissection does not portend high rates of level IV involvement. Supraomohyoid neck dissection is therefore adequate for this subset of patients.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Article Selection
Figure 2.
Figure 2.. Rate of Level IV Involvement and True Skip Metastasis in Preoperative Patients With Clinically Node-Negative Necks
Figure 3.
Figure 3.. Oral Tongue Primary: Rate of Level IV Involvement in Preoperative Patients With Clinically Node-Negative Necks
See this image and copyright information in PMC

Comment in

References

    1. Huang SF, Kang CJ, Lin CY, et al. Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer. 2008;112(5):1066-1075. doi: 10.1002/cncr.23278 - DOI - PubMed
    1. Lindberg R. Distribution of cervical lymph node metastasis from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer. 1972;29(6):1446-1449. doi: 10.1002/1097-0142(197206)29:6<1446::AID-CNCR2820290604>3.0.CO;2-C - DOI - PubMed
    1. Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980. Am J Surg. 1985;150(4):414-421. doi: 10.1016/0002-9610(85)90146-1 - DOI - PubMed
    1. Ballantyne AJ. Neck dissection for cancer. Curr Probl Cancer. 1985;9(8):1-34. doi: 10.1016/S0147-0272(85)80024-6 - DOI - PubMed
    1. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastasis from squamous carcinoma of the oral cavity. Cancer. 1990;66(1):109-113. doi: 10.1002/1097-0142(19900701)66:1<109::AID-CNCR2820660120>3.0.CO;2-A - DOI - PubMed

MeSH terms