6. Qualitätsindikatoren – Speicheldrüsentumoren
Qualitätsindikatoren sind Messgrößen, deren Erhebung der Beurteilung der Qualität der zugrunde liegenden Strukturen, Prozesse bzw. Ergebnisse dient. Qualitätsindikatoren sind ein wichtiges Instrument des Qualitätsmanagements. Ziel ihres Einsatzes ist die stetige Verbesserung der Versorgung, indem die Ergebnisse der Versorgung dargestellt, kritisch reflektiert und wenn nötig verbessert werden. Die vorliegende Auswahl von Qualitätsindikatoren wurde gemäß der Methodik des Leitlinienprogramms Onkologie erstellt [172]. Für den Ableitungsprozess konstituierte sich eine „Arbeitsgruppe Qualitätsindikatoren“ (AG QI). Diese erstellte das finale Set der Qualitätsindikatoren auf Grundlage der starken Empfehlungen („soll“) der neu erarbeiteten Leitlinie „Speicheldrüsentumore des Kopfes“, sowie der Ergebnisse der Recherche nach bestehenden internationalen Qualitätsindikatoren. Die genaue Vorgehensweise und die Zusammensetzung der AG QI sind im Leitlinienreport [2] dargelegt.
Nach zwei Online-Sitzungen dieser AG wurde das finale Set von 10 Qualitätsindikatoren (QI) definiert und angenommen.
Qualitätsindikatoren
Der Zähler ist stets eine Teilmenge des Nenners.
Die Qualitätsindikatoren 2, 3, 4 und 8 sind mit dem onkologischen Basisdatensatz der Krebsregister zu dokumentieren (Stand: 01/2025).
1: Intraoperatives Neuromonitoring bei Operationen an der Gl. parotidea
Zähler
Pat. des Nenners mit intra-operativem Neuromonitoring
Nenner
Alle Pat. mit operativem Eingriff an der Gl. parotidea
Qualitätsziel / Referenzbereich
EK, starker Konsens
Qualitätsziel:
Möglichst häufig Neuromonitoring* bei operativen Eingriffen an der Gl. Parotidea
*OPS Code 5-262.04 oder 5-262.05 oder 5-262.14 oder 15 (OPS-Version 2025)
Referenz-Empfehlungen
Bei allen Eingriffen an der Gl. parotidea sollen Neuromonitoring und Vergrößerungshilfen (Lupenbrille, Operationsmikroskop) verwendet werden.
- Konsens
- Starker Konsens (100%)
2: Interdisziplinäre Tumorkonferenz
Zähler
Pat. des Nenners mit Vorstellung in der interdisziplinären Tumorkonferenz¹ ¹Teilnehmende Tumorkonferenz: MKG-Chirurgie, HNO, Strahlentherapie, Onkologie, Radiologie, Pathologie
Nenner
Alle Pat. mit bösartigen Tumoren der Speicheldrüse
Qualitätsziel / Referenzbereich
EK, starker Konsens (100%)
Qualitätsziel:
Möglichst häufig Vorstellung von Pat. mit malignem Speicheldrüsentumor in der interdisziplinären Tumor-konferenz
Referenz-Empfehlungen
Die Therapieempfehlung bei bösartigen Tumoren der Speicheldrüsen sollen in der interdisziplinären Tumorkonferenz, bestehend aus Vertreter*innen der Fachabteilungen Mund-, Kiefer- und Gesichtschirurgie, Hals-, Nasen-, Ohrenheilkunde; Strahlentherapie; Onkologie; Radiologie und Pathologie getroffen werden.
- Konsens
- Starker Konsens (100%)
3: Psychoonkologisches Distress-Screening
Zähler
Pat. des Nenners mit psychoonkologischem Distress-Screening
Nenner
Alle Pat. mit Erstdiagnose eines bösartigen Speicheldrüsentumors
Qualitätsziel / Referenzbereich
EK, starker Konsens
Qualitätsziel:
Möglichst häufig Angebot eines psychoonkologischen Distress-Screenings bei Pat. mit Erstdiagnose eines bösartigen Speicheldrüsentumors
Referenz-Empfehlungen
Ab Diagnosestellung eines bösartigen Speicheldrüsentumors soll dem Patienten/der Patientin eine Beratung durch die Psychoonkologie angeboten werden.
- Konsens
- Starker Konsens (100%)
- Literatur
- [51]
4: R0 Resektion bei Karzinomen der Gl. parotidea
Zähler
Pat. des Nenners mit R0-Resektion
Nenner
Alle Pat. mit Erstdiagnose eines Speicheldrüsenkarzinoms der Gl. parotidea ohne Fernmeta-stasierung (M0) und chirurgischer Resektion
Qualitätsziel / Referenzbereich
EG A, LoE 4
Qualitätsziel:
Möglichst häufig R0-Resektion von Speicheldrüsenkarzinomen der Gl. parotidea
Referenz-Empfehlungen
Die primäre Therapie eines Speicheldrüsenkarzinoms ohne Fernmetastasierung besteht in der chirurgischen Resektion unter Mitnahme von umgebenden Speicheldrüsenparenchyms bis hin zur totalen Parotidektomie (R0-Resektion).
5: Submandibulektomie und Neck Dissection bei Karzinomen der Gl. submandibularis
Zähler
Pat. des Nenners mit Submandibulektomie und Neck Dissection (mind. der Level I-III)
Nenner
Alle Pat. mit Erstdiagnose eines intrakapsulären Karzinoms der Gl. submandibularis und chirurgischer Resektion
Qualitätsziel / Referenzbereich
EK, starker Konsens
Qualitätsziel:
Möglichst häufig Submandibulektomie und Neck Dissection der Level I-III* bei intrakapsulären Karzinoms der Gl. Submandibularis
*OPS Code 5-403.02/.03/.04/.05, 5.-403.1, 5-403.2, 5-403.3 (OPS Version 2025)
Referenz-Empfehlungen
Maligne intrakapsuläre Karzinome der Gl. submandibularis sollen in Form einer Submandibulektomie mit Neck Dissection der Level I-III therapiert werden.
- Konsens
- Starker Konsens (100%)
6: Ipsilaterale modifiziert radikale zervikale Lymphknotendissektion bei ≥cN1
Zähler
Pat. des Nenners mit ipsilateraler modifiziert radikaler zervikaler Lymphknotendissektion
Nenner
Alle Pat. mit klinisch o. radiologisch positivem zervikalen Lymphknotenbefund (≥cN1) mit bösartigen Tumoren der Speicheldrüsen und chirurgischer Resektion
Qualitätsziel / Referenzbereich
EG A, LoE 4
Qualitätsziel:
Möglichst häufig modifiziert radikale zervikale Lymphknotendissektion* bei positivem zervikalen Lymphknotenbefund in der prätherapeutischen Diagnostik
*OPS Code 5.-403.1, 5-403.2, 5-403.3 (OPS-Version 2025)
Referenz-Empfehlungen
Bei einem positivem zervikalen Lymphknotenbefund in der prätherapeutischen Diagnostik soll eine therapeutische, modifiziert radikale zervikale Lymphknotendissektion durchgeführt werden.
7: Ipsilaterale zervikale Lymphadenektomie bei Tumoren der Gl. parotidea
Zähler
Pat. des Nenners mit ipsilateraler elektiver zervikaler Lymphadenektomie
Nenner
Alle Pat. mit Tumoren der Gl. parotidea mit • high-grade Histologien u/o • Karzinom mit high-grade Transformation u/o • Fortgeschrittener Tumor-größe (T3/T4) u/o • mit extraparenchymalem Wachstum und chirurgischer Resektion
Qualitätsziel / Referenzbereich
EG A, LoE 4.
Qualitätsziel:
Möglichst häufig ipsilaterale elektive zervikale Lymphadenektomie* bei Pat. mit Tumoren der Gl. parotidea und high-grade Histologien u/o Karzinom mit high-grade Transformation u/o fortgeschrittener Tumorgröße (T3/T4) u/o extraparenchymalem Wachstum
*OPS Code 5-403.02/.03/.04/.05, 5.-403.1, 5-403.2, 5-403.3 (OPS-Version 2025)
Referenz-Empfehlungen
Bei high-grade Histologien und Karzinomen mit high-grade Transformation, fortgeschrittener Tumorgröße (T3/T4) oder Tumoren der Ohrspeicheldrüse mit extraparenchymalem Wachstum soll auch ohne Hinweis auf eine zervikale lymphogene Aussaat (cN0) eine ipsilaterale elektive zervikale Lymphadenektomie erfolgen.
- Empfehlungsgrad
- A: Starke Empfehlung für oder gegen ein Maßnahme - verwendete Ausdrucksweise = soll/soll nicht
- Evidenzlevel
- 4
- Konsens
- Starker Konsens (100%)
- Literatur
- [86] [87] [88] [89] [90] [91]
Änderungshinweis
Bei high-grade Histologien (Karzinom ex pleomorphes Adenom, duktales Adenokarzinom, nicht näher klassifiziertes Adenokarzinom, high-grade Mukoepidermoidkarzinom, undifferenziertes Karzinom, adenoid-zystisches Karzinom und Azinuszellkarzinom mit jeweils high-grade Transformation), fortgeschrittener Tumorgröße (T3/T4) oder Tumoren der Ohrspeicheldrüse mit extraparenchymalem Wachstum sollte auch ohne Hinweis auf eine zervikale lymphogene Aussaat (cN0) eine elektive zervikale Lymphadenektomie erfolgen.8: Postoperative Strahlentherapie
Zähler
Pat. des Nenners mit postoperativer Strahlentherapie
Nenner
Alle Pat. mit Speicheldrüsenkarzinom mit • T3-4 Tumor u/o • high-grade Tumor u/o • Vorliegen von Lymphknotenmetastasierung u/o • positivem Resektionsrand (<1mm) u/o • Perineuralscheideninfiltration u/o • Lymphgefäß-/o. Blutgefäß-invasion (L1 o. V1) oder adenoidzystischem Karzinom und chirurgischer Resektion
Qualitätsziel / Referenzbereich
EK, starker Konsens
Qualitätsziel:
Möglichst häufig postoperative Strahlentherapie bei Pat. mit Speicheldrüsenkarzinom
- mit T3-4Tumor u./o.
- mit high grade Tumor u./o.
- Lymphknotenmetastasierung u./o.
- positivem Resektionsrand (<1mm) u./o.
- Pn1 u./o.
- L1 o.V1
oder adenoidzystischem Karzinom
und chirurgischer Resektion
Referenz-Empfehlungen
Eine postoperative Strahlentherapie soll durchgeführt werden bei:
- Vorliegen von mindestens einem der folgenden Risikofaktoren: T3-4 Tumor, high-grade Tumor, Vorliegen von Lymphknotenmetastasierung, positiver Resektionsrand (<1mm), Perineuralscheideninfiltration, Lymphgefäß- oder Blutgefäßinvasion (L1 oder V1)
- allen adenoidzystischen Karzinomen
Eine postoperative Strahlentherapie kann durchgeführt werden bei:
Intermediate-grade Tumoren und knappem Resektionsrand (1-3 mm).
9: Applizierte Gesamtdosis bei definitiver Strahlentherapie
Zähler
Pat. des Nenners mit Applikation einer GD von ≥72 Gy (normofraktioniert) im high-risk PTV (Zielvolumen) und ≥50 Gy im elektiven PTV
Nenner
Alle Pat. mit Speicheldrüsenkarzinom und Bestrahlung als definitiver Therapie
Qualitätsziel / Referenzbereich
EK
Qualitätsziel:
Möglichst häufig Applikation von ≥72 Gy (normofraktioniert) im high-risk PTV (Zielvolumen) und ≥50 Gy im elektiven PTV bei definitiver Bestrahlung eines Speicheldrüsenkarzinoms
Referenz-Empfehlungen
Dosisverschreibung in der postoperativen Situation:
- Im high-risk PTV sollte normofraktioniert eine Dosis von mindestens 60 Gy und im Falle eines knappen/positiven Resektionsrandes und/oder einer Perineuralscheideninfiltration mindestens eine Dosis von 64-66 Gy appliziert werden.
- Im elektiven PTV sollte eine Dosis von 50 Gy appliziert werden.
Dosisverschreibung in der definitiven Situation:
- Im high-risk PTV soll normofraktioniert eine Dosis von mindestens 72 Gy appliziert werden.
- Im elektiven PTV soll eine Dosis von 50 Gy appliziert werden.
- Konsens
- Starker Konsens
10: Zahnärztliche Untersuchung vor Radio- oder Radiochemotherapie
Zähler
Pat. des Nenners mit zahnärztlicher Untersuchung vor Beginn der Radio- oder Radiochemotherapie
Nenner
Alle Pat. malignem Tumor der Speicheldrüse und Radio- oder Radiochemotherapie
Qualitätsziel / Referenzbereich
EK
Qualitätsziel:
Möglichst häufig Applikation von ≥72 Gy (normofraktioniert) im high-risk PTV (Zielvolumen) und ≥50 Gy im elektiven PTV bei definitiver Bestrahlung eines Speicheldrüsenkarzinoms
Anmerkung
Spezifisches Ziel auf Basis QPI5 (Healthcare Improvement Scotland and National Health Services Scotland, Head and Neck Cancer - Clinical QPI)
Numerator:
Number of patients with head and neck cancer undergoing treatment with curative intent who are identified by the Restorative Consultant and the MDT as requiring pre-treatment assessment that have assessment carried out before initiation of treatment.
Denominator:
All patients with head and neck cancer undergoing treatment with curative intent who are identified by the Restorative Consultant and the MDT as requiring pre-treatment assessment.
Referenz-Empfehlungen
Evidenztabellen
Welches chirurgische Verfahren ist bei bösartigen Tumoren der großen Speicheldrüsen zur lokalen Tumorkontrolle effektiv?
Schlüsselfrage:
Sammlung 07. Welches chirurgische Verfahren ist bei bösartigen Tumoren der großen Speicheldrüsen zur lokalen Tumorkontrolle effektiv?
Inhalt: 2 Literaturstellen
|
Literaturstelle |
Evidenzlevel |
Studientyp |
|
Israel, Y. 2017 [53] |
4 |
Retrospective Cohort Study |
|
Papadogeorgakis, N. 2012 [52] |
4 |
Retrospective Cohort Study |
NEWCASTLE - OTTAWA Checklist: Cohort: 2 Bewertung(en)
|
Israel, Y. et al. Diagnostic and therapeutic modalities for 287 malignant and benign salivary tumors: A cohort study. J Craniomaxillofac Surg. 45. 585-588. 2017 |
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|
Evidence level |
Methodical Notes |
Patient characteristics |
Interventions |
|
Evidence level: 4Study type: Retrospective Cohort Study The purpose of this study was to analyze diagnostic and therapeutic modalities used in our medical center for the various tumor types and the different anatomical sites of occurrence. |
Funding sources: NoneConflict of Interests: None Randomization: Blinding: Dropout rates: |
Total no. patients: 287 patientsRecruiting Phase: 1996 to 2015 Inclusion criteria: Exclusion criteria: |
Interventions: Patients with benign tumorsComparison: Patients with malignant tumors |
|
Notes: |
Oxford CEBM Level of Evidence 2011: EL 4 Retrospective Cohort Study |
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Outcome Measures/results |
Primary Diagnostic and therapeutic modalitiesSecondary |
Results: Of 287 cases, 216 had benign tumors and 71 had malignant tumors. Treatment was surgerybased in 99% of cases, often accompanied by radiotherapy and/or chemotherapy. Rates of imaging and biopsy for diagnosis were significantly higher in malignant than benign tumors. Fine-needle aspiration (FNA) was used in 90.3% of benign tumors. Of 71 malignant tumors, 69 underwent surgery to fully remove the malignant tumor. Adjuvant therapy included 22 neck dissections (30%), 28 radiotherapy (39.4%), 12 chemotherapy (16.9%) and 10 combined radio-chemotherapy (14.1%). Partial parotidectomy, submandibular sialoadenectomy and local excision were used in 78.1%, 8.3% and 6.9% of benign cases. Total parotidectomy, sub-total maxillectomy and wide excision were used in 16.9%, 12.7% and 22.6% of malignant cases |
|
|
Papadogeorgakis, N. et al. Management of malignant parotid tumors. Oral Maxillofac Surg. 16. 29-34. 2012 |
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|
Evidence level |
Methodical Notes |
Patient characteristics |
Interventions |
|
Evidence level: 4Study type: Retrospective Cohort Study |
Funding sources: NoneConflict of Interests: None Randomization: Blinding: Dropout rates: |
Total no. patients: 31Recruiting Phase: 1996 and 2008 Inclusion criteria: Patients with the diagnosis of primary malignant parotid tumors were admitted to our institution during the selected time frame Exclusion criteria: In six patients, surgery was not included in their treatment, due to advanced disease or poor medical condition, so they were excluded from this study |
Interventions: Management of patients with malignant parotid tumorsComparison: |
|
Notes: |
Oxford CEBM Level of Evidence 2011: EL 4 Retrospective Cohort Study |
||
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Outcome Measures/results |
Primary Oncologic efficacy of the treatment was evaluated, focusingon clinical outcome and especially survival. Secondary |
Results: With reference to the extent of tissue removed, PSP was performed in 11 patients; SP, in 14 patients; and TRP, in 6 patients. The decision on the type of parotidectomy was determined by the ability to obtain a clear safety margin (at least 1 cm). In cases where the tumor extended to the deep lobe with intraoperative facial nerve invasion, a TRP was performed (6 cases; Table 2). In all cases of TRP and in four cases of SP (see below), the main trunk or branches of the facial nerve were sacrificed, and a reconstruction during surgery was attempted. For the reconstruction of the facial nerve, the great auricular nerve was used in four patients, ansa hypoglossus combined with great auricular in three patients, ansa hypoglossus in two patients, and in one patient, direct anastomosis was performed.In the 14 patients in which a typical SP was performed, the tumors were confined to the superficial lobe, but a clear margin could not be achieved without resecting the entire superficial lobe. In four of these patients, branches of the facial nerve were sacrificed. In the 11 patients who underwent a PSP, the tumor was confined to the superficial lobe, and a sufficient resection margin at the horizontal level could be achieved, while there was no presence of intraoperative facial nerve invasion (Table 2). The median time of follow-up was 64 months, ranging from 8 to 144 months. Eight patients developed recurrences. Six patients died within the follow-up time. The overall survival rates at 5 and 10 years were 82.2% and 76.7%, respectively. The 5- and 10-year disease-free survival rates were 74.8% and 69.8%, respectively. |
|
Wie effektiv ist eine elektive Neck Dissection in der Therapie maligner Speicheldrüsentumoren?
Schlüsselfrage:
Sammlung 08. Wie effektiv ist eine elektive Neck Dissection in der Therapie maligner Speicheldrüsentumoren?
Inhalt: 4 Literaturstellen
|
Literaturstelle |
Evidenzlevel |
Studientyp |
|
Harbison, R. A. 2019 |
4 |
Retrospective, multicenter cohort study |
|
Kaura, A. 2019 |
4 |
Retrospective Cohort Study |
|
Luksic, I. 2019 |
3 |
Systematic Review of Retrospective Studies (18 studies, 5767 patients) |
|
Ning, C. 2018 |
3 |
Systematic Review and Meta-Analysis of Retrospective Studies (18 studies, 2993 patients) |
OXFORD (2011) Appraisal Sheet: Systematic Reviews: 2 Bewertung(en)
|
Luksic, I. et al. Elective neck dissection in adenoid cystic carcinoma of head and neck: yes or no? A systematic review. Eur Arch Otorhinolaryngol. 276. 2957-2962. 2019 |
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|
Evidence level/Study Types |
P - I - C |
Outcomes/Results |
Literature References |
|
|
Evidence level: 3Study type: Systematic Review of Retrospective Studies (18 studies, 5767 patients) Databases: PubMed, MEDLINE, EMBASE, Web of Science, ScienceDirect, and Scopus Search period: Inception to August 5, 2019 Inclusion Criteria: (1) AdCCHN, (2) primary surgical treatment including END, and (3) known data regarding occult neck disease rates. Exclusion Criteria: (1) specific diagnosis of adenoid cystic carcinoma could not be separated from other salivary gland tumours reported (aggregated salivary gland histology subtypes); (2) no information on lymph node status (clinically and histopathologic); (3) END rates not stated; (4) tumours that arose primarily at extremely rare subsites (lacrimal gland, external auditory canal) and those with low incidence ( <0.5% overall) of occult neck disease (laryngeal AdCC); (5) less than ten cases of AdCCHN treated with END. > |
Population: Patients with adenoid cystic carcinoma of head and neck (AdCCHN)Intervention: Elective neck dissection Comparison: |
Primary: Occult neck metastasesSecondary: Results: This analysis included a total of 5767 AdCCHN patients with 2450 ENDs, ranging from 10 to 1190. Elective lymphadenectomy was employed in 42.5% of patients with AdCCHN (range 9.2–100%). The overall rate of occult neck metastases in patients with AdCCHN was reported to range between 0 and 43.7%, the average being 13.9%. Author's Conclusion: If performed, END should be limited to levels I–III of the ipsilateral neck since occult metastases are exclusively located within these neck regions. Although END is associated with a prolonged regional recurrence-free period, it infuence on fnal outcome or survival is still controversial. This review strongly supports conduction of prospective trials on indications, prognostic signifcance and extent of END in AdCCHN. |
18 studies (5767 patients) included: Agarwal 2008, Ali 2017, Amit 2013, Amit 2015, Balamucki 2012, Bhayani 2012, Cohen 2004, Cordesmeyer 2018, Garden 1995, Iyer 2010, Lee 2013, Lee 2014, Luksic 2016, Nobis 2014, Qian 2019, Stenner 2012, Wang 2012, Xiao 2019 |
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Methodical Notes |
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Funding Sources: Not declaredCOI: Not declared Study Quality: Not investigated Heterogeneity: No meta-analysis was conducted Publication Bias: Not investigated Notes: Oxford CEBM Level of Evidence 2011: EL 3 Systematic Review of Retrospective Studies -No search for grey literature or unpublished studies was conducted -Insufficient description of search terms -Quality of the included primary studies was not investigated -No declaration of funding or conflict of interest |
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Ning, C. et al. Cervical lymph node metastases in salivary gland adenoid cystic carcinoma: a systematic review and meta-analysis. Cancer Manag Res. 10. 1677-1685. 2018 |
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Evidence level/Study Types |
P - I - C |
Outcomes/Results |
Literature References |
|
|
Evidence level: 3Study type: Systematic Review and Meta-Analysis of Retrospective Studies (18 studies, 2993 patients) To determine whether neck dissection is necessary for the ACC of head and neck by analyzing the frequency of cervical lymph node metastases with meta-analysis. Databases: Web of Science, PubMed, and Ovid Search period: Inception to October 14, 2017 Inclusion Criteria: 1. Researches that investigated the frequency of cervical lymph node metastases in primary salivary gland ACC of head and neck. 2. The researches included data that can be extractable, and cervical lymph node metastases were confirmed by pathology. Exclusion Criteria: 1. Researches on patients who had undergone preoperative radiotherapy and chemotherapy. 2. Researches that only investigated ACC of the upper respiratory or sinonasal. 3. Researches that only investigated clinical cervical metastases in salivary gland ACC. Single case reports and articles in languages other than English and Chinese were also excluded. |
Population: Patients with primary salivary gland Adenoid cystic carcinoma (ACC) of head and neckIntervention: Comparison: |
Primary: Frequency of cervical lymph node metastasesSecondary: Results: In total, 18 studies involving 2993 patients were included in the analysis. Of the 2993 patients, 473 patients had cervical lymph node metastasis, with a merge frequency of 16% (95% CI: 13–19). Among included articles, only 4 involved cervical lymph node occult metastases, with a merge frequency of 14% (95% CI: 9–20). There were 5 articles containing minor salivary glands (MiSGs) involving 370 patients of which 92 patients had cervical lymph node metastases and the merge frequency was 25% (95% CI: 11–38). Moreover, there were 4 studies on major salivary glands involving 904 patients of which 158 patients had cervical lymph node metastases and the merge frequency was 17% (95% CI: 15–20). Author's Conclusion: Elective neck dissection is unnecessary for all patients with salivary gland ACC of head and neck. Moreover, compared with major salivary glands, MiSGs have a higher cervical lymph node metastases rate in ACC. The overall cervical lymph node metastases rate of MiSGs is 25%, which is enough to attract our attention. Therefore, we suggest that neck dissection might be applied to ACC of MiSGs. |
18 studies (2993 patients): Bhayani 2012, Amit 2015, Min 2012, Liu 2015, Megwala and Sirjani 2017, Mücke 2010, van Weert 2013, Jang 2017, Ali 2017, Meyers 2016, Bjorndal 2015, Ko 2016, Hämetoja 2017, Mannelli 2017, Ouyang 2016, Zhang 2013, Kruse 2010, Lee 2014 |
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Methodical Notes |
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Funding Sources: Not describedCOI: None Study Quality: Unclear which tool was used for quality assessment. Among 18 included studies, 4 had a relatively low quality and 14 had a high-quality design as found by quality assessment. Heterogeneity: Chi-squared-based Q test and I 2 were used for heterogeneity evaluation. The fixed-effect model was used when there was no heterogeneity (P > 0.10 and I 2 < 0.10 or I2 >50%). Substantial heterogeneity was present for the outcomes: Overall cervical metastases rate (I2= 76%)and Metastases rate of ACC of MiSGs (I2=88%). Moderate heterogeneity for the outcome Cervical lymph node occult metastases rate (I2=56%) Publication Bias: Publication bias was evaluated using the Funnel plots. The relevant Funnel plot revealed that the majority of articles were close to axis and there was no publication bias in these researches for cervical lymph node overall metastases about ACC, cervical lymph node occult metastases, cervical lymph node metastases about ACC of MiSGs, cervical lymph node metastases rate about ACC of MaSGs Notes: Oxford CEBM Level of Evidence 2011: EL 3 Systematic Review and Meta-Analysis of Retrospective Studies -No search for grey literature or unpublished articles conducted -Inclusion criteria and PICO were not described sufficiently -Quality of the primary studies was investigated but not reported in detail in the review. Unclear which tool was used for the quality assessment -Substantial to moderate heterogeneity was present for the main outcomes which was not investigated or discussed |
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NEWCASTLE - OTTAWA Checklist: Cohort: 2 Bewertung(en)
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Harbison, R. A. et al. The role of elective neck dissection in high-grade parotid malignancy: A hospital-based cohort study. Laryngoscope. . . 2019 |
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Evidence level |
Methodical Notes |
Patient characteristics |
Interventions |
|
Evidence level: 4Study type: Retrospective, multicenter cohort study To assess the effect of END on 3- and 5-year survival among cN0 patients with high-grade parotid cancer |
Funding sources: This work was supported by a National Institute on Deafness and Other Communication Disorders grant (T32DC000018)Conflict of Interests: none Randomization: n.a. Blinding: n.a. Dropout rates: n.a. |
Total no. patients: 1547 patientsRecruiting Phase: January 1, 2004 and December 31, 2013 Inclusion criteria: Patients diagnosed as having parotid carcinomas from January 1, 2004 to December 31, 2013 were identified using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) topography code C07.9 Exclusion criteria: We excluded the following histologic subtypes: adenoid cystic carcinoma, skin cancers, other nonintrinsic tumors (e.g., Merkel cell, adnexal tumors, secretory carcinoma of breast, extra-adrenal paraganglioma, sarcomas, medulloblastoma, and granular cell tumors), hemangiopericytoma, and polymorphous low-grade adenocarcinoma. Given the distinct clinical behavior of adenoid cystic carcinoma (ACC) and that distant metastasis occurs in up to 40% of ACCs,17 we excluded ACC cases to minimize bias secondary to decreased survival from distant metastasis and differential clinical behavior from other histologies. Additionally, we excluded cases with ICD-O-3 morphological codes 8070, 8071, 8072, 8073, 8074, 8075, 8078, 8083, 8084, 8090, 8092, 8094, 8097, 8098, 8102, 8123, 8200, 8247, 8401, 8407, 8410, 8413, 8420, 8502, 8525, 8693, 8720, 8730, 8742, 8745, 8772, 9150, 9180, 9220, 9260, 9473, 9540, 9560, and 9580. In addition, patients with clinical evidence of nodal disease (cN1 or higher), patients with low-grade (grade 1 or 2) parotid malignancies, and cases diagnosed at the reporting facility that did not receive treatment at that facility. We also excluded cases where nodes were reported as examined by a pathologist without a corresponding neck dissection reported. |
Interventions: Elective neck dissection (END)Comparison: |
|
Notes: |
Oxford CEBM Level of Evidence: 4 Retrospective cohort study |
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Outcome Measures/results |
Primary 3- and 5-year survivalSecondary |
Results: This study did not find a statistically significant effect of END on survival at 3-years postdiagnosis after adjusting for potential confounders and treatment received. Therefore, we conclude that END may be used selectively in patients with clinically node-negative, high-grade parotid carcinoma given that they will likely achieve equivalent overall survival with adjuvant radiation. However, we cannot draw true causal inferences with the current data due to the lack of randomization. In summary, END is beneficial for prognostication and is therapeutic, especially in patients who are at risk of loss to follow-up or unable to receive adjuvant radiation, though prospective research is warranted to assess the effect of END on locoregional control among patients with cN0 high-grade parotid carcinoma. |
|
|
Kaura, A. et al. Utility of neck dissection for management of carcinoma of the parotid gland. Br J Oral Maxillofac Surg. . . 2019 |
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Evidence level |
Methodical Notes |
Patient characteristics |
Interventions |
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Evidence level: 4Study type: Retrospective Cohort Study To establish the frequency with which neck dissection was undertaken for parotid carcinoma within a London hospital, and to validate its use by establishing the incidence of metastasis to the cervical lymph nodes. |
Funding sources: n.a.Conflict of Interests: None Randomization: n.a. Blinding: n.a. Dropout rates: n.a. |
Total no. patients: 82 patientsRecruiting Phase: 1992-2014 Inclusion criteria: Patients who had primary resection of parotid carcinomas at the head and neck unit between 1992 and 2014. Exclusion criteria: One patient was excluded as it was not possible to establish the T stage. |
Interventions: Neck dissection in the treatment of carcinoma of the parotid glandComparison: |
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Notes: |
Oxford CEBM Level of Evidence 2011: EL 4 Retrospective Cohort Study |
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Outcome Measures/results |
Primary Incidence of metastatic diseaseSecondary |
Results: The group comprised 82 patients (42 women and 40 men, median (range) age 57 (10 – 84) years). A total of 54 of the 82 patients identified had neck dissections. Forty-three of the 54 who had neck dissections had had a preoperative diagnosis of carcinoma, and seven had had a preoperative diagnosis that was suspicious of malignancy. Nodal metastases were detected in 10 with high-grade, invasive carcinoma ex-pleomorphic adenomas, two with salivary duct carcinomas, one with a high-grade adenocarcinoma not otherwise specified (NOS), one with an adenoid cystic carcinoma, and one with a high-grade acinic cell carcinoma. No metastases were found in those with a low-grade acinic cell carcinoma, low-grade mucoepidermoid carcinoma, epithelial-myoepithelial carcinoma, or non-invasive carcinoma ex-pleomorphic adenoma. Median survival was 2.11 years and five-year survival between 11% and 22%. Ten-year estimated survival was between 0 and 11%. |
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