The Prognosis And Clinical Features Of Retropharyngeal Lymph Node Metastasis In Oropharyngeal And Hypopharyngeal Squamous Cell Carcinoma:A Meta Analysis

Objective:To compare the prognosis and clinical features of oropharyngeal and hypopharyngeal squamous cell carcinoma(SCC)with or without retropharyngeal lymph node metastasis using the method of Meta analysis,summarize the correlation between the clinical features of primary tumors and retropharyngeal lymph node metastasis and analyze the influence of retropharyngeal lymph node metastasis on the prognosis of oropharyngeal and hypopharyngeal squamous cell carcinoma.Methods:The inclusion criteria and exclusion criteria for included literatures were established.Pubmed,Cochrane,Web of Science,CNKI,VIP and Wanfang databases were searched for published literatures on retropharyngeal lymph node metastasis of oropharyngeal and hypopharyngeal squamous cell carcinoma(1900,2021).By reading the title and eliminate repetition and unrelated literature,some outcome indicators such as survival rate and related clinical features were extracted.The quality evaluation of the included literatures were carried out.RevMan5.4 was used for meta-analysis of survival rate,clinical stages and other indicators.Heterogeneity test was conducted for the results and appropriate effect model was selected for analysis.Stata16.0 software was used for combined image diagnosis,including combination sensitivity,combination specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio.Sensitivity analysis was performed on the included literature.The publication bias test was performed for studies with≥10 articles included.Results:A total of 18 literatures were included.Results of the Meta analysis showed that 3-year survival rate(46.1%),5-year survival rate(40.8%)and 5-year disease-specific survival rate(35.9%)of patients with oropharyngeal and hypopharyngeal squamous cell carcinoma with retropharyngeal lymph node metastasis were lower than those without metastasis(53.0%,62.5%and 53.1%,respectively).The difference was statistically significant(OR values were 0.26,0.38,0.38,95%CI were 0.10-0.69,0.28-0.51,0.23-0.65,respectively;All P values<0.05).There were statistically significant differences in clinical stage(Ⅲ-Ⅳ),T stage(T3+T4),N stage(N2),positive cervical lymph node metastasis and number of lymph node metastasis(≥3)between the group with retropharyngeal lymph node metastasis and the group without metastasis(OR values were 4.28,2.20,2.88,10.83,6.53,respectively;95%CI were 1.70-10.74,1.35-3.58,1.90-4.34,3.57-32.95,1.75-24.38,respectively,P<0.05).The sensitivity and specificity of preoperative imaging for diagnosing retropharyngeal lymph nodes were 0.72(95%CI=0.54-0.85)and 0.98(95%CI=0.74-1.00),and the area under curve(AUC)of Summary Receiver Operating Characteristic curve(SROC)is 0.84(95%CI=0.80～0.87).Conclusion:In this study,the survival rate of patients with oropharyngeal or hypopharyngeal squamous cell carcinoma with retropharyngeal lymph node metastasis was significantly reduced,the clinical stage and T stage were late,and the cervical lymph node metastasis rate was high.Retropharyngeal lymph node metastasis is more insidious,preoperative imaging diagnosis accuracy is not high.