Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity

A meta-analysis of reported studies

Authors

  • Shao Hui Huang MSc,

    1. Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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  • David Hwang MB,

    1. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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  • Gina Lockwood MMath,

    1. Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • David P. Goldstein MD,

    1. Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
    2. Department Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Brian O'Sullivan MD

    Corresponding author
    1. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
    2. Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
    • Room 5-624, Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, ON, Canada. M5G 2M9===

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    • Fax: (416) 946-6566


Abstract

BACKGROUND:

Tumor thickness (TT) appears to be a strong predictor for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity (OSCC), but a precise clinically optimal TT cutoff point has not been established. To address this question, the authors conducted a meta-analysis.

METHODS:

All relevant articles were identified from MEDLINE and EMBASE as well as from cross-referenced publications cited in relevant articles. Lymph-node involvement was confirmed and identified as positive lymph-node declaration (PLND) by either pathologic positivity on immediate neck dissection or by neck recurrence identified after follow-up ≥2 years. Odds ratios (OR) were calculated to quantify the predictive value of TT. Negative predictive values (and the percentage of patients falsely predicted to not have PLND [FN-PLND]) were compared to determine the optimal TT cutoff point.

RESULTS:

Sixteen studies were selected from 72 potential studies, yielding a pooled total of 1136 patients. Data were examined for the following TT cutoff points: 3 mm (4 studies, 387 patients), 4 mm (9 studies, 778 patients), 5 mm (6 studies, 367 patients), and 6 mm (4 studies, 488 patients). The OR (95% CI) was 7.3 (5.3-10.1) for the overall group. The proportion of FN-PLND was 5.3% (95% CI, 2.0-11.2), 4.5% (2.6-7.2), 16.6% (11.5-22.8), and 13.0% (9.7-16.9) for TT<3, <4, <5, and <6 mm, respectively. There was a statistically significant difference between the 4-mm and 5-mm TT cutoff points (P = .007).

CONCLUSIONS:

TT was a strong predictor for cervical lymph-node involvement. The optimal TT cutoff point was 4 mm. Cancer 2009. © 2009 American Cancer Society.

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