Clin Exp Otorhinolaryngol.  2022 Feb;15(1):107-114. 10.21053/ceo.2020.02411.

Sentinel Lymph Node Biopsy Versus Elective Neck Dissection: Long-Term Oncologic Outcomes in Clinically Node-Negative Tongue Cancer

• Park W
• Jin H
• Heo Y
• Jeong HS
• Son YI
• Chung MK
• Baek CH

• KMID: 2527119
• DOI: http://doi.org/10.21053/ceo.2020.02411

Abstract

Objectives
. The aim of this study was to compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer.
Methods
. This was a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group.
Results
. The overall recurrence rate showed no significant difference between the two groups. The regional control rate was also comparable between the two groups (P=0.490). The 5-year recurrence-free survival (RFS) was slightly better in the SLNB group than in the END group (P=0.427). The 5-year overall survival (OS) rate was 89.9% in the SLNB group versus 91.9% in the END group (P=0.737). In a propensity-matched subgroup analysis, the type of neck management did not affect RFS or OS.
Conclusion
. SLNB showed non-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.

Keyword

Recurrence; Sentinel Lymph Node; Neck Dissection

Figure

• 

  Fig. 1. Clinical course of the elective neck dissection (END) group and sentinel lymph node biopsy (SLNB) group.

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  Fig. 2. Kaplan-Meier estimates of the sentinel lymph node biopsy (SLNB) group and elective neck dissection (END) group. (A) Five-year recurrence-free survival: END 79.5% vs. SLNB 84.6% (P=0.427). (B) Five-year overall survival: END 91.9% vs. SLNB 89.9% (P=0.737).

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  Fig. 3. Kaplan-Meier estimates of the sentinel lymph node biopsy (SLNB) subgroup and elective neck dissection (END) subgroup after propensity-matching analysis. (A) Five-year recurrence-free survival: END 78.7% vs. SLNB 84.8% (P=0.423). (B) Five-year overall survival: END 90.6% vs. SLNB 89.7% (P=0.899).

Reference

1. Rogers SN, Brown JS, Woolgar JA, Lowe D, Magennis P, Shaw RJ, et al. Survival following primary surgery for oral cancer. Oral Oncol. 2009; Mar. 45(3):201–11.

2. Woolgar JA, Rogers S, West CR, Errington RD, Brown JS, Vaughan ED. Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol. 1999; May. 35(3):257–65.

3. Teichgraeber JF, Clairmont AA. The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: treatment rationale. Head Neck Surg. 1984; Oct. 7(1):15–21.

4. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994; Nov. 168(5):391–4.

5. D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015; Aug. 373(6):521–9.

6. Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer. 2015; Dec. 51(18):2777–84.

7. Schilling C, Shaw R, Schache A, McMahon J, Chegini S, Kerawala C, et al. Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now. Br J Oral Maxillofac Surg. 2017; Oct. 55(8):757–62.

8. Samant S. Sentinel node biopsy as an alternative to elective neck dissection for staging of early oral carcinoma. Head Neck. 2014; Feb. 36(2):241–6.

9. Flach GB, Bloemena E, Klop WM, van Es RJ, Schepman KP, Hoekstra OS, et al. Sentinel lymph node biopsy in clinically N0 T1-T2 staged oral cancer: the Dutch multicenter trial. Oral Oncol. 2014; Oct. 50(10):1020–4.

10. Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, et al. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010; Mar. 28(8):1395–400.

11. Wu JX, Hanson M, Shaha AR. Sentinel node biopsy for cancer of the oral cavity. J Surg Oncol. 2019; Aug. 120(2):99–100.

12. Krishnamurthy A. Current status and future perspectives of sentinel lymph node biopsy in oral cancers. Indian J Dent Res. 2017; May-Jun. 28(3):239–40.

13. Hernando J, Villarreal P, Alvarez-Marcos F, Gallego L, Garcia-Consuegra L, Junquera L. Comparison of related complications: sentinel node biopsy versus elective neck dissection. Int J Oral Maxillofac Surg. 2014; Nov. 43(11):1307–12.

14. Den Toom IJ, Heuveling DA, Flach GB, van Weert S, Karagozoglu KH, van Schie A, et al. Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience. Head Neck. 2015; Apr. 37(4):573–8.

15. Stoeckli SJ, Alkureishi LW, Ross GL. Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2009; Jun. 266(6):787–93.

16. Garrel R, Poissonnet G, Temam S, Dolivet G, Fakhry N, de Raucourt D. Review of sentinel node procedure in cN0 head and neck squamous cell carcinomas: guidelines from the French evaluation cooperative subgroup of GETTEC. Eur Ann Otorhinolaryngol Head Neck Dis. 2017; Apr. 134(2):89–93.

17. Seim NB, Wright CL, Agrawal A. Contemporary use of sentinel lymph node biopsy in the head and neck. World J Otorhinolaryngol Head Neck Surg. 2016; Jul. 2(2):117–25.

18. Cramer JD, Sridharan S, Ferris RL, Duvvuri U, Samant S. Sentinel lymph node biopsy versus elective neck dissection for stage I to II oral cavity cancer. Laryngoscope. 2019; Jan. 129(1):162–9.

19. Fan SF, Zeng ZY, Peng HW, Guo ZM, Wang SL, Zhang Q. Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; Feb. 117(2):186–90.

20. Chung MK, Lee GJ, Choi N, Cho JK, Jeong HS, Baek CH. Comparative study of sentinel lymph node biopsy in clinically N0 oral tongue squamous cell carcinoma: long-term oncologic outcomes between validation and application phases. Oral Oncol. 2015; Oct. 51(10):914–20.

21. Jeong HS, Baek CH, Son YI, Cho DY, Chung MK, Min JY, et al. Sentinel lymph node radiolocalization with 99mTc filtered tin colloid in clinically node-negative squamous cell carcinomas of the oral cavity. J Korean Med Sci. 2006; Oct. 21(5):865–70.

22. Moya-Plana A, Auperin A, Guerlain J, Gorphe P, Casiraghi O, Mamelle G, et al. Sentinel node biopsy in early oral squamous cell carcinomas: long-term follow-up and nodal failure analysis. Oral Oncol. 2018; Jul. 82:187–94.