Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review.

Álvaro Sanábria ,Trinitia Cannon,Juan P Rodrigo,Alessandra Rinaldo,Kerry D Olsen,Robert P Takes,Carl E Silver,Marc Hamoir,K Thomas Robbins,Carlos Suárez,Primož Strojan,Remco De Bree,Elisabeth V Sjögren,Ashok R Shaha,Alfio Ferlito,Jatin P Shah,Jesús E Medina ,Antti Mäkitie ,Luiz Paulo Kowalski ,Andrés Coca‐Pelaz

doi:10.3390/cancers12041059

Abstract

Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.

Highlights

The larynx is the site for the second most common cancer of the upper aerodigestive tract
Zhang et al [31] reported individual data about subsites and were divided in order to include their cases in different categories [glottic, supraglottic or larynx, not otherwise specified (LNOS)] (Table 1)
In the subgroup of supraglottic tumors, the pooled incidence was 34.0%

Summary

Introduction

The larynx is the site for the second most common cancer of the upper aerodigestive tract. Adequate treatment of larynx cancer centers around local control of the primary tumor, as well as control of clinical or occult neck lymph node metastasis. The lymph node levels to be included in the dissection and the radiotherapy fields depend on the level of positive nodes found by palpation and radiological examination, as well as the laryngeal subsite(s) involved by cancer and Tclassification of the tumor. Larynx cancer is a common site for tumors of the upper aerodigestive tract. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved.

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Discussion

Conclusion