Incidence of pathologically positive lymph node in clinico-radiologic T4b oral squamous cell carcinoma: a meta-analysis

2 Jun 2026

Sameer Pandey, Sooraj Pillai, Megha Punetha, Santhosh Rao

Background: Clinico-radiologic T4b oral squamous cell carcinoma (OSCC) lesions form the most advanced cohort of oral malignancy. Survival outcomes depend on major prognostic determinants, such as nodal status. The anatomic extent of disease determines triage for curative-intent surgery.

Purpose: The purpose of the meta-analysis was to find the incidence of lymph-node metastasis and estimate the survival outcomes of patients with cT4b OSCC treated with curative intent surgery.

Data sources: PubMed, Scopus, Ovid, Cochrane Library, Embase and ClinicalKey databases were searched from July 2005 to July 2024. A manual search of speciality journals was conducted from July 2005 to July 2024, without any language restriction and reporting only human studies.

Study selection: All randomised controlled trials (RCTs), non-RCTs, prospective, retrospective studies based on cT4b OSCC of all subsites except tongue were included in the review.

Methods for selecting the study: Studies were reviewed by two reviewers, and a third reviewer resolved any disagreements.

Data extraction and synthesis: The extracted data were recorded in a pre-piloted Excel sheet. The synthesis of results was performed using MedCalc version 23.0.6 software.

Main outcomes and measures: A PRISMA-guided systematic review was conducted. Data on the incidence of N0 disease, the number of cases with clear surgical margins, overall survival and disease-free survival were recorded. Based on data homogeneity, a proportional meta-analysis was performed to evaluate the weighted incidence of N0 disease.

Results: Eleven studies were shortlisted for data extraction. Due to heterogeneous surgical techniques and criteria for surgical margins and survival duration, outcomes were analysed only for the incidence of N0 disease. Results suggested that 40.58% of patients had pathologically N0 disease. There was statistically significant heterogeneity (I2 = 93%).

Conclusion and relevance Among patients with cT4b OSCC, 40.58% have negative neck disease, with carefully evaluated information on anatomic spread, a curative intent surgical treatment plan can be designed.