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A Systematic Review and Meta-analysis

W. Cooper Scurry Jr, MD; David Goldenberg, MD; Michael Y. Chee, BS; Eugene J. Lengerich, VMD, MS; Yihai Liu, PhD, MS; Fred G. Fedok, MD

Arch Otolaryngol Head Neck Surg. 2007;133(8):796-800.

Objective  To demonstrate whether the regional recurrence (RR) of squamous cell carcinoma (SCC) of the nasal cavity is higher than previously suspected.

Data Sources  Original articles, including a previously published series from our institution, were identified from systematic searches of the MEDLINE database.

Study Selection  Studies that analyzed tumors other than SCC or tumors from sites other than the nasal cavity were excluded. Studies that did not report an RR were also excluded.

Data Extraction  Studies identified by the literature search were reviewed by a single reviewer (W.C.S.), and studies not excluded were reviewed for data extraction by 2 reviewers (W.C.S. and M.Y.C.).

Data Synthesis  From the 23 studies reviewed, the average weighted percentage RR for SCC of the nasal cavity was 18.1% (95% confidence interval, 13.4%-22.8%).

Conclusions  Currently, few authors advocate elective treatment of the neck in patients with high-risk SCC of the nasal cavity. The results of this systematic review and meta-analysis demonstrate that the RR of this entity may be higher than previously suspected. Because many studies included other histopathologies or analyzed recurrence data from tumors of multiple subsites, a true RR for SCC of the nasal cavity has not been firmly established. Now that a uniform staging system exists for nasal cavity cancers, better prospective analysis of these tumors will be available. The authors suggest that the risk of RR of certain high-risk SCCs of the nasal cavity to the lymph nodes, including the perifacial and upper cervical lymphatics, may approach the frequently cited 20% risk suggestive of consideration for elective regional therapy.

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (Drs Scurry, Goldenberg, and Fedok and Mr Chee), and Division of Epidemiology, Department of Health Evaluation Sciences (Dr Lengerich), Penn State University College of Medicine, Hershey, Pennsylvania; and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Liu).