Cervical level IIb metastases in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis

Figures & data

Table 1 The literature quality evaluation of AHRQ

Item	Yes	No	Unclear
1) Define the source of information (survey, record review)
2) List the inclusion and exclusion criteria for exposed and unexposed subjects (cases and controls) or refer to previous publications
3) Indicate the time period used for identifying patients
4) Indicate whether or not subjects were consecutive, if not population based
5) Indicate if evaluators of subject components of the study were masked to other aspects of the status of the participants
6) Describe any assessments undertaken for quality assurance purposes (eg, test/retest of primary outcome measurements)
7) Explain any patient exclusions from the analysis
8) Describe how confounding was assessed and/or controlled
9) If applicable, explain how missing data were handled in the analysis
10) Summarize patient response rates and completeness of data collection
11) Clarify what follow-up, if any, was expected and the percentage of patients for which incomplete data or follow-up was obtained

Abbreviation: AHRQ, Agency for Healthcare Research and Quality.

Figure 1 Flow diagram for the identified published studies included in the meta-analysis.

Table 2 Information from 22 studies included in the analysis

Authors	Year	Recruitment years	Total OSCC cases	cN0	cN+	The OSCC cases of IIb metastases	Metastatic rate, %
Lim et al^Citation15	2004	1997–2001	74	74	0	4	5.00
De Vicente et al^Citation20	2015	2010–2011	56	27	29	1	1.80
Maher and Hoffman^Citation21	2014	2006–2013	71	71	0	4	5.60
Koerdt et al^Citation18	2016	2011–2014	112	–	–	16	12.60
Bartella et al^Citation22	2016	2012–2015	183	116	67	6	3.30
Manola et al^Citation19	2011	2002–2006	38	16	22	8	21.00
Smith et al^Citation23	2007	2002–2004	34	–	–	3	8.00
Hoyt et al^Citation24	2008	2002–2006	78	46	32	5	6.40
Agarwal et al^Citation25	2016	2011–2015	231	231	0	2	0.86
Bhattacharya et al^Citation26	2015	–	30	–	–	2	6.67
Corlette et al^Citation27	2005	1998–2003	56	–	–	4	7.14
Chone et al^Citation28	2000	1988–1997	25	–	–	1	3.60
Elsheikh et al^Citation29	2005	2001–2004	48	48	0	5	10.40
Talmi et al^Citation30	1998	1995–1996	33	–	–	2	6.06
Santoro et al^Citation31	2008	2004–2007	47	40	7	1	2.13
Silverman et al^Citation32	2003	1998–2001	35	–	–	1	2.86
Pantvaidya et al^Citation33	2014	2008–2011	583	–	–	22	3.80
Villaret et al^Citation34	2007	2003–2005	111	54	57	11	9.91
Dabholkar and Kapre^Citation35	2016	2011–2012	65	–	–	7	10.44
Ghantous et al^Citation36	2016	2000–2011	70	35	35	5	7.14
Paleri et al^Citation37	2007	–	10	–	–	1	2.60
Chiesa et al^Citation38	2000	1997–1998	11	11	0	1	9.09
Total cases			2001	769	249	112

Note: “–”, Data not provided.

Abbreviation: OSCC, oral squamous cell carcinoma.

Table 3 A summary of patient characteristics among those with level IIb metastases

Authors	Year	Cases	IIb metastases cases	IIb metastases patients’ specific information						Isolated IIb metastases	Distribution of positive level lymph nodes (for cases IIb+)
				Site	Cases	T (no)
						T1	T2	T3	T4
Lim et al^Citation15	2004	74	4	Tongue	4	–	4	–	–	0	I, IIa, III
De Vicente et al^Citation20	2015	56	1	Tongue	1	1	–	–	–	0	IIa, III
Maher and Hoffman^Citation21	2014	71	4	Tongue	3	–	2	1	–	2	IIa, III
				Retromolar trigone	1	–	–	–	1	–	–
Smith et al^Citation23	2007	34	3	–	–	–	1	–	2	–	–
Hoyt et al^Citation24	2008	78	5	–	–	–	2	1	2	–	–
Agarwal et al^Citation25	2016	231	2	Buccal mucosa	–	–	–	–	–	–	–
Bhattacharya et al^Citation26	2015	30	2	Anterior alveolus mandible	1	1	–	–	–	0	IIa
				Buccal mucosa	1	–	1	–	–	–	–
Elsheikh et al^Citation29	2005	48	5	–	–	–	–	–	–	0	IIa
Talmi et al^Citation30	1998	33	2	Tongue	1	–	–	–	–	–	–
				Alveolar ridge	1	–	–	–	1	–	–
Santoro et al^Citation31	2008	47	1	–	–	–	1	–	–	0	IIa
Silverman et al^Citation32	2003	35	1	–	–	–	–	–	1	0	IIa, III
Paleri et al^Citation37	2007	10	1	FOM	–	–	–	–	1	1	–
Chiesa et al^Citation38	2000	11	1	Tongue	1	1	–	–	–	–	–

Note: “–”, Data not provided.

Abbreviation: FOM, floor of mouth.

Table 4 Special information about the tongue squamous cell carcinoma

Authors	Year	Total tongue SCC cases	Tongue SCC cases of IIb metastases	Tongue SCC IIb metastases rate, %
Lim et al^Citation15	2004	51	4	7.84
De Vicente et al^Citation20	2015	20	1	5.00
Maher and Hoffman^Citation21	2014	27	3	11.11
Koerdt et al^Citation18	2016	40	3	7.50
Manola et al^Citation19	2011	38	8	21.05
Elsheikh et al^Citation29	2005	23	5	21.74
Talmi et al^Citation30	1998	16	1	6.25
Silverman et al^Citation32	2003	16	1	6.25
Pantvaidya et al^Citation33	2014	121	6	5.00
Dabholkar and Kapre^Citation35	2016	29	3	10.34
Ghantous et al^Citation36	2016	8	1	12.50
Chiesa et al^Citation38	2000	11	1	9.09
Total cases		400	37

Abbreviation: SCC, squamous cell carcinoma.

Figure 2 Forest plot for cervical level IIb metastasis rate for OSCC.

Note: Chi-square based Q test was used for heterogeneity evaluation of these studies (χ²=0.00, I²=72%, P<0.1), so the random effects model should be used and the cervical IIb metastatic rate for OSCC was 6%.
Abbreviations: df, degrees of freedom; IV, inverse variance; OSCC, oral squamous cell carcinoma; RD, risk difference; SE, standard error.

Figure 3 Funnel plot for cervical level IIb metastasis rate for OSCC.

Note: Plot indicates that there was no publication bias in these studies.
Abbreviations: OSCC, oral squamous cell carcinoma; RD, risk difference.

Figure 4 Forest plot for cervical level IIb metastasis rate for tongue SCC.

Note: Chi-square based Q test was used for heterogeneity evaluation of these studies (χ²=9.77, I²=0%, P<0.1), so the fixed-effects model was used and the cervical IIb metastasis rate for tongue SCC was 7%.
Abbreviations: df, degrees of freedom; IV, inverse variance; SCC, squamous cell carcinoma; RD, risk difference; SE, standard error.

Figure 5 Funnel plot for cervical level IIb metastasis rate for tongue SCC.

Note: Plot indicates that there was no publication bias in these studies.
Abbreviations: RD, risk difference; SCC, squamous cell carcinoma; SE, standard error.

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