Comparison Of Neck Recurrence And Survival Outcomes Of Patients With Oral Squamous Cell Carcinoma In CN0pN+ Stage With Selective And Comprehensive Neck Dissection:A Meta-analysis

Objective: There has been no consensus on the optimal treatment for lymph node metastasis in patients with oral squamous cell carcinoma(OSCC)with a clinically node-negative(c N0)but pathologically node-positive(p N+)neck.In this study,the effects of selective and comprehensive neck dissection on the neck recurrence and survival outcomes of oral squamous cell carcinoma patients with a c N0 p N+ neck were systematically evaluated by meta-analysis,providing a reference for improving the postoperative efficacy and quality of life of patients.Methods: The comparative study of selective neck dissection(SND)and comprehensive neck dissection(RND,MRND or CND)in patients with c N0 p N+ oral squamous cell carcinoma was collected by searching Pub Med,Web-of-Science,Cochrane library,Embase,CNKI,Wanfang and VIP databases with computer,which was up to October 1,2020.Two researchers independently screened the literature,extracted data,and assessed the risk of bias in the included study,and then conducted meta analysis with Review Manager 5.3 software.Results: A total of 9 cohort studies were included,including 259 cases in selective neck dissection group and 370 cases in comprehensive neck dissection group.Outcome indicators included neck recurrence rate,overall survival rate(OS)and disease-specific survival rate(DSS).6 articles could be evaluated for the overall survival rate,with the fixed effect model RR=0.99,95%CI(0.83,1.18),P=0.91.5 articles could be evaluated for the neck recurrence rate,with the fixed effect model RR=0.82,95%CI(0.56,1.20),P=0.30.4 articles could be evaluated for the disease-specific survival rate,with the fixed effect model RR=1.13,95%CI(0.93,1.37),P=0.21.No significant difference was found,suggesting that the survival prognosis of selective was the same as the comprehensive neck dissection.Neither egger test nor begg test showed significant publication bias.Conclusion: 1.There was no significant difference in the survival rate and neck control rate between SND and CND in OSCC patients with c N0 p N+ neck.SND can achieve satisfactory neck control effect and survival prognosis.