FLEX November 2023

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10970347, 2022, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/hed.27121 by Mount Sinai Health System Icah, Wiley Online Library on [02/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

2296

COSTANTINO ET AL .

TABLE 3

Sentinel lymph node basin stratified by primary tumor location

No. of sentinel lymph node by location (%)

External jugular

Postauricular/ suboccipital

Other cervical not specified (%)

Tsite

Parotid Level 1 Level 2 Level 3 Level 4 Level 5

Scalp

16 (12)

4 (3)

43 (33)

17 (13)

0 (0)

18 (14)

12 (9)

17 (13)

2 (2)

Forehead

3 (21)

1 (7)

10 (71)

0 (0)

Cheek

23 (29)

4 (5)

30 (38)

2 (3)

3 (4)

10 (13)

0 (0)

5 (6)

Ear

19 (18)

0 (0)

61 (59)

4 (4)

2 (2)

1 (1)

6 (6)

2 (2)

8 (8)

Neck

0 (0)

4 (24)

1 (6)

5 (29)

1 (6)

0 (0)

6 (35)

Nose

3 (8)

22 (58)

6 (16)

1 (3)

0 (0)

6 (16)

Periocular

7 (39)

1 (6)

6 (33)

1 (6)

0 (0)

1 (6)

2 (11)

0 (0)

Lip

0 (0)

46 (82)

6 (11)

0 (0)

3 (5)

0 (0)

1 (2)

Temple

13 (39)

0 (0)

11 (33)

2 (6)

0 (0)

1 (3)

0 (0)

6 (18)

Postauricular/ occipital

2 (7)

0 (0)

17 (55)

1 (3)

0 (0)

6 (19)

5 (16)

Chin

0 (0)

6 (80)

2 (20)

0 (0)

Head

1 (20)

0 (0)

1 (20)

3 (60)

Face

8 (73)

1 (9)

0 (0)

2 (18)

Total

95 (18)

85 (16)

196 (36) 29 (5)

12 (2)

24 (4)

31 (6)

26 (5)

44 (8)

(95%CI: 0.5 – 7.2; Figure 3C) was measured using a random effect modeling. The between-study variance was esti mated at τ 2 = 0.019 (95%CI: 0.005 – 0.073), with an I 2 value of 66.2% (95%CI: 44.5 – 79.4). Baujat plot showing the stud ies contribution to the overall heterogeneity is shown in Figure 4C. Influence analysis identified no influential studies on the cumulative SLN identification rate, SLNB positive rate, and RRR. Meta-regression showed a nonsignificant linear associa tion between the SLNB technique and the SLN identifica tion rate ( p = 0.70), SLNB positive rate ( p = 0.46), and RRR ( p = 0.78). Accordingly, the residual between-study hetero geneity does not differ after the inclusion of the SLNB tech nique in the model, confirming its limited impact on the SLN identification rate ( I 2 = 61.8%; Q = 47.2, p < 0.05), SLNB positive rate ( I 2 = 60.1%; Q = 45.2, p < 0.05), and RRR( I 2 = 67.6%; Q = 49.4, p < 0.05).

outcomes. 12 As a consequence, early detection of occult metastases may determine an advantage in terms of tumor control and survival. END in head and neck muco sal SCC is usually performed when the likelihood of occult nodal metastases is greater than 15% – 20%, 64,65 based on decision analyses that have taken into account the risk – benefit ratio related to the oncologic benefit and surgical morbidity. 66,67 Tumor size and thickness, histo logical differentiation, other than specific tumor location, have been found as predictors of lymph node metastases and survival. 13 – 16 In addition, also patient-related factors (e.g., chronic immunosuppression) should be considered. 68 However, the risk of regional metastases varies signifi cantly among different patients, and it is difficult to be determined precisely. A recent retrospective case – control study showed that in patients with cSCCHN observation of the neck resulted in noninferior survival rates compared to END, even if a relatively high-rate of occult meta stases (21%) may suggest a potential role of END in selected cases. 23 Elective treatment of the neck is not rec ommended by current clinical guidelines even in high-risk cSCCHN, 19 and low evidence can be extracted from the current literature. In this context, SLNB may represent a valuable treatment option to improve regional disease con trol, reducing surgical morbidity of END. Our meta-analysis measured a pooled SLN identifica tion rate of 98.8%, demonstrating the feasibility of this procedure also in cSCCHN. The main reasons for failure

4 | DISCUSSION

The management of clinically node negative cSCCHN remains controversial, and different strategies may be chosen in each clinical context. 20 Even if the relatively low rate of regional disease at presentation make obser vation an adequate “ treatment ” option, 7 – 11 lymph node metastases are associated with unfavorable oncologic

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