Primary neck management among patients with cancer of the oral cavity without clinical nodal metastases: A decision and sensitivity analysis
✍ Scribed by Satoshi Kaneko; Takesumi Yoshimura; Kunio Ikemura; Kanemitsu Shirasuna; Jingo Kusukawa; Masamichi Ohishi; Ryosuke Shiba; Hajime Sunakawa; Kazuhiro Tominaga; Kazumasa Sugihara; Masanori Shinohara; Takeshi Katsuki; Shigetaka Yanagisawa; Hideo Kurokawa; Tamotsu Mimura; Hisazumi Ikeda; Shigeru Yamabe; Satoru Ozeki
- Publisher
- John Wiley and Sons
- Year
- 2002
- Tongue
- English
- Weight
- 152 KB
- Volume
- 24
- Category
- Article
- ISSN
- 1043-3074
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✦ Synopsis
Background:
A standardized neck management strategy for oral cancer patients without clinical nodal metastases remains to be established. consequently, a decision and sensitivity analysis of two neck management protocols, involving either prophylactic neck dissection or careful observation, was conducted using the oral cancer registry of kyushu, japan.
Methods:
We calculated probabilities of subclinical nodal metastases and 5-year survival using the registry data. a two-way sensitive analysis was conducted using the probabilities and parameters of the complete nodal metastasis resection rate (x) and a utility rating that describes the health state induced by dissection (y) compared with the neck condition in a careful-observation group.
Results:
We solved the threshold curve for y and x for the expected utility between the two groups. the results showed that prophylactic neck dissection must guarantee a complete resection of subclinical nodal metastases with no disadvantage to health state to be evaluated as equally satisfactory as careful observation.
Conclusions:
Careful observation involving standardized systematic preoperative and postoperative screening of the neck seems preferable to prophylactic neck dissection for oral cancer patients without subclinical nodal metastases.