{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:56:23Z","timestamp":1789833383111,"version":"4.0.1"},"reference-count":76,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4\u201323.4) and 8.0% (95% CI 2.7\u201313.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0\u20136.1%), 2.0% (95% CI 0.9\u20133.1) and 0.4% (95% CI 0\u20131.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0\u20131.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3\u20134 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.<\/jats:p>","DOI":"10.3390\/cancers12041059","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T11:42:14Z","timestamp":1587728534000},"page":"1059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Alvaro","family":"Sanabria","sequence":"first","affiliation":[{"name":"Department of Surgery, School of Medicine, Universidad de Antioquia\/Hospital Universitario San Vicente Fundaci\u00f3n, Medell\u00edn 050010, Colombia"},{"name":"CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medell\u00edn 050021, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jatin P.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus E.","family":"Medina","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry D.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Thomas","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl E.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85259, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-0890","authenticated-orcid":false,"given":"Juan P.","family":"Rodrigo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain"},{"name":"University of Oviedo-IUOPA,  33011 Oviedo, Spain"},{"name":"Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Coca-Pelaz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain"},{"name":"University of Oviedo-IUOPA,  33011 Oviedo, Spain"},{"name":"Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok R.","family":"Shaha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0451-2404","authenticated-orcid":false,"given":"Antti A.","family":"M\u00e4kitie","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"University of Udine School of Medicine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-5814","authenticated-orcid":false,"given":"Remco","family":"de Bree","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-112X","authenticated-orcid":false,"given":"Primo\u017e","family":"Strojan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Institute of Oncology, SI-1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2768","authenticated-orcid":false,"given":"Marc","family":"Hamoir","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Takes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth V.","family":"Sj\u00f6gren","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trinitia","family":"Cannon","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, NC 27609, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-156X","authenticated-orcid":false,"given":"Luiz P.","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, 01509-900 S\u00e3o Paulo, Brazil"},{"name":"Department of Head and Neck Surgery, University of S\u00e3o Paulo Medical School, 05402-000 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfio","family":"Ferlito","sequence":"additional","affiliation":[{"name":"International Head and Neck Scientific Group, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/j.ejca.2007.12.015","article-title":"Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s","volume":"44","author":"Soerjomataram","year":"2008","journal-title":"Eur. J. 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