口腔癌 pN1 患者术后放疗与单纯手术治疗的比较：荟萃分析

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-05-15 DOI:10.1002/lio2.1260

Tsung-You Tsai MD, Pin-Chun Chiang MD, Wing-Keen Yap MD, Yenlin Huang MD, PhD, Anna See MMed, MPH, Shao-Yu Hung MD, Chuieng-Yi Lu MD, Chien-Yu Lin MD, Tung-Chieh Joseph Chang MD, Huang-Kai Kao MD, Kai-Ping Chang MD, PhD

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引用次数: 0

摘要

目的本荟萃分析旨在评估口腔鳞状细胞癌 pN1 患者术后放疗（PORT）的潜在益处。方法在 2023 年 1 月之前通过主要数据库进行文献检索。提取并汇总了不同生存结果的调整后危险比（aHR）或风险比（RR）及 95% 置信区间（CI）。结果本次荟萃分析纳入了 2005 年至 2022 年间发表的 10 项研究，汇总患者人数为 2888 人。由于研究设计和报告结果的不同，这些研究被分为不同的组别。在无结节外扩展（ENE）的pN1患者中，PORT与总生存期（OS）的显著改善相关（aHR 0.76，95% CI：0.61-0.94）。在没有ENE和边缘阳性的pN1患者中，PORT可改善OS（aHR 0.71，95% CI：0.56-0.89），并与较低的区域复发率相关（RR 0.35，95% CI：0.15-0.83）。然而，在没有 ENE、边缘阳性、神经周围侵犯和淋巴管侵犯的 pN1 患者中，PORT 组和观察组在 5 年 OS（RR 0.48，95% CI：0.07-3.41）或 5 年无病生存率（RR 0.37，95% CI：0.07-2.06）方面均无显著差异。结论目前的研究表明，PORT 有可能改善 pN1 疾病的 OS。然而，是否使用 PORT 仍取决于不同的临床情况，因此有必要进行更多的研究，以提供更具结论性的解决方案。证据等级 2。

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Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta-analysis

Objectives

The aim of this meta-analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.

Methods

A literature search through major databases was conducted until January 2023. The adjusted hazard ratio (aHR) or risk ratio (RR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled.

Results

Ten studies published between 2005 and 2022, with a pooled patient population of 2888, were included in this meta-analysis. Due to differences in study design and reported outcomes, the studies were categorized into distinct groups. In pN1 patients without extranodal extension (ENE), PORT was associated with a significant improvement in overall survival (OS) (aHR 0.76, 95% CI: 0.61–0.94). In pN1 patients without ENE and positive margins, PORT improved OS (aHR 0.71, 95% CI: 0.56–0.89) and was associated with a lower regional recurrence rate (RR 0.35, 95% CI: 0.15–0.83). However, in pN1 patients without ENE, positive margins, perineural invasion, and lymphovascular invasion, there were no significant differences observed between the PORT and observation groups in either 5-year OS (RR 0.48, 95% CI: 0.07–3.41) or 5-year disease-free survival (RR 0.37, 95% CI: 0.07–2.06).

Conclusions

The current study demonstrated that PORT has the potential to improve OS in pN1 disease. However, the decision of whether to administer PORT still hinges on diverse clinical scenarios, and additional research is necessary to furnish a more conclusive resolution.