{"title":"头颈部鳞状细胞癌术后辅助化疗与术后辅助放疗的不良病理结果：系统综述与荟萃分析","authors":"Gabriela Garcia Korczaguin , Gilberto Vaz Teixeira , Ashok Shaha","doi":"10.1016/j.bjorl.2024.101516","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>Postoperative chemoradiotherapy has arisen as an adjuvant option for head and neck cancers, but its superiority to radiotherapy alone in patients with adverse pathologic factors is not yet well defined. We aimed to perform an updated meta-analysis comparing outcomes in head and neck cancer patients with adverse pathologic factors who underwent postoperative chemoradiotherapy and radiotherapy alone.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for Randomised Controlled Trials (RCTs) in patients submitted to postoperative adjuvant therapy with radiotherapy alone or chemoradiotherapy.</div></div><div><h3>Results</h3><div>We included 8 studies with a total of 2376 patients, of whom 1183 (49.8%) underwent postoperative chemoradiotherapy. In pooled analysis, overall survival (HR<!--> <!-->=<!--> <!-->0.86; 95% CI 0.76‒0.98; <em>p</em> <!-->=<!--> <!-->0.64; I<sup>2</sup> <!-->=<!--> <!-->0%) and disease-free survival (HR<!--> <!-->=<!--> <!-->0.85; 95% CI 0.75‒0.96; <em>p</em> <!-->=<!--> <!-->0.64; I<sup>2</sup> <!-->=<!--> <!-->0%) were shown to be superior in patients undergoing combined therapy. Chemoradiotherapy was also associated with significantly lower locoregional recurrence. However, there was no significant difference in distant metastasis occurrence between both groups. In an analysis of the extracapsular extension subgroup, the overall survival (OR<!--> <!-->=<!--> <!-->3.12; 95% CI 1.76–5.51; <em>p</em> <!-->=<!--> <!-->0.78; I<sup>2</sup> <!-->=<!--> <!-->0%), disease-free survival (OR<!--> <!-->=<!--> <!-->3.44; 95% CI 2.00‒5.91; <em>p</em> <!-->=<!--> <!-->0.68; I<sup>2</sup> <!-->=<!--> <!-->0%), and locoregional control (OR<!--> <!-->=<!--> <!-->1.86; 95% CI 1.16‒2.99; <em>p</em> <!-->=<!--> <!-->0.98; I<sup>2</sup> <!-->=<!--> <!-->0%) were better in the postoperative adjuvant chemoradiotherapy branch over radiotherapy alone.</div></div><div><h3>Conclusion</h3><div>The results of our meta-analysis suggest that postoperative adjuvant chemoradiotherapy in patients with head and neck cancer with adverse pathologic factors favors a superior survival and a better locoregional control compared to postoperative radiotherapy alone, despite not affecting the ocurrence of distant metastasis.</div></div>","PeriodicalId":49099,"journal":{"name":"Brazilian Journal of Otorhinolaryngology","volume":"91 1","pages":"Article 101516"},"PeriodicalIF":1.7000,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative adjuvant chemoradiotherapy versus postoperative adjuvant radiotherapy for head and neck squamous cell carcinoma with adverse pathology: a systematic review and meta-analysis\",\"authors\":\"Gabriela Garcia Korczaguin , Gilberto Vaz Teixeira , Ashok Shaha\",\"doi\":\"10.1016/j.bjorl.2024.101516\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>Postoperative chemoradiotherapy has arisen as an adjuvant option for head and neck cancers, but its superiority to radiotherapy alone in patients with adverse pathologic factors is not yet well defined. We aimed to perform an updated meta-analysis comparing outcomes in head and neck cancer patients with adverse pathologic factors who underwent postoperative chemoradiotherapy and radiotherapy alone.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for Randomised Controlled Trials (RCTs) in patients submitted to postoperative adjuvant therapy with radiotherapy alone or chemoradiotherapy.</div></div><div><h3>Results</h3><div>We included 8 studies with a total of 2376 patients, of whom 1183 (49.8%) underwent postoperative chemoradiotherapy. In pooled analysis, overall survival (HR<!--> <!-->=<!--> <!-->0.86; 95% CI 0.76‒0.98; <em>p</em> <!-->=<!--> <!-->0.64; I<sup>2</sup> <!-->=<!--> <!-->0%) and disease-free survival (HR<!--> <!-->=<!--> <!-->0.85; 95% CI 0.75‒0.96; <em>p</em> <!-->=<!--> <!-->0.64; I<sup>2</sup> <!-->=<!--> <!-->0%) were shown to be superior in patients undergoing combined therapy. Chemoradiotherapy was also associated with significantly lower locoregional recurrence. However, there was no significant difference in distant metastasis occurrence between both groups. In an analysis of the extracapsular extension subgroup, the overall survival (OR<!--> <!-->=<!--> <!-->3.12; 95% CI 1.76–5.51; <em>p</em> <!-->=<!--> <!-->0.78; I<sup>2</sup> <!-->=<!--> <!-->0%), disease-free survival (OR<!--> <!-->=<!--> <!-->3.44; 95% CI 2.00‒5.91; <em>p</em> <!-->=<!--> <!-->0.68; I<sup>2</sup> <!-->=<!--> <!-->0%), and locoregional control (OR<!--> <!-->=<!--> <!-->1.86; 95% CI 1.16‒2.99; <em>p</em> <!-->=<!--> <!-->0.98; I<sup>2</sup> <!-->=<!--> <!-->0%) were better in the postoperative adjuvant chemoradiotherapy branch over radiotherapy alone.</div></div><div><h3>Conclusion</h3><div>The results of our meta-analysis suggest that postoperative adjuvant chemoradiotherapy in patients with head and neck cancer with adverse pathologic factors favors a superior survival and a better locoregional control compared to postoperative radiotherapy alone, despite not affecting the ocurrence of distant metastasis.</div></div>\",\"PeriodicalId\":49099,\"journal\":{\"name\":\"Brazilian Journal of Otorhinolaryngology\",\"volume\":\"91 1\",\"pages\":\"Article 101516\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-10-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brazilian Journal of Otorhinolaryngology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1808869424001319\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brazilian Journal of Otorhinolaryngology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1808869424001319","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的 术后化放疗已成为头颈部癌症的一种辅助治疗方法，但在有不良病理因素的患者中，化放疗优于单纯放疗的情况尚未明确。我们旨在进行一项最新的荟萃分析，比较有不良病理因素的头颈部癌症患者术后化放疗和单纯放疗的疗效。方法我们系统检索了PubMed、Scopus和Cochrane对照试验中央注册中心的随机对照试验（RCTs），研究对象为接受术后辅助治疗、单纯放疗或化疗的患者。结果我们纳入了8项研究，共2376名患者，其中1183人（49.8%）接受了术后化疗。汇总分析表明，接受联合治疗的患者总生存期（HR = 0.86；95% CI 0.76-0.98；P = 0.64；I2 = 0%）和无病生存期（HR = 0.85；95% CI 0.75-0.96；P = 0.64；I2 = 0%）更优。化放疗也与显著降低局部复发率有关。不过，两组患者的远处转移发生率没有明显差异。在囊外扩展亚组的分析中，术后辅助化放疗组的总生存率（OR = 3.12；95% CI 1.76-5.51；P = 0.78；I2 = 0%）、无病生存率（OR = 3.44；95% CI 2.00-5.91；P = 0.68；I2 = 0%）和局部控制率（OR = 1.86；95% CI 1.16-2.99；P = 0.98；I2 = 0%）均优于单纯放疗组。结论我们的荟萃分析结果表明，与单纯术后放疗相比，对有不良病理因素的头颈部癌症患者进行术后辅助化放疗有利于提高患者的生存率和局部控制率，尽管这不会影响远处转移的发生。
Postoperative adjuvant chemoradiotherapy versus postoperative adjuvant radiotherapy for head and neck squamous cell carcinoma with adverse pathology: a systematic review and meta-analysis
Objectives
Postoperative chemoradiotherapy has arisen as an adjuvant option for head and neck cancers, but its superiority to radiotherapy alone in patients with adverse pathologic factors is not yet well defined. We aimed to perform an updated meta-analysis comparing outcomes in head and neck cancer patients with adverse pathologic factors who underwent postoperative chemoradiotherapy and radiotherapy alone.
Methods
We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for Randomised Controlled Trials (RCTs) in patients submitted to postoperative adjuvant therapy with radiotherapy alone or chemoradiotherapy.
Results
We included 8 studies with a total of 2376 patients, of whom 1183 (49.8%) underwent postoperative chemoradiotherapy. In pooled analysis, overall survival (HR = 0.86; 95% CI 0.76‒0.98; p = 0.64; I2 = 0%) and disease-free survival (HR = 0.85; 95% CI 0.75‒0.96; p = 0.64; I2 = 0%) were shown to be superior in patients undergoing combined therapy. Chemoradiotherapy was also associated with significantly lower locoregional recurrence. However, there was no significant difference in distant metastasis occurrence between both groups. In an analysis of the extracapsular extension subgroup, the overall survival (OR = 3.12; 95% CI 1.76–5.51; p = 0.78; I2 = 0%), disease-free survival (OR = 3.44; 95% CI 2.00‒5.91; p = 0.68; I2 = 0%), and locoregional control (OR = 1.86; 95% CI 1.16‒2.99; p = 0.98; I2 = 0%) were better in the postoperative adjuvant chemoradiotherapy branch over radiotherapy alone.
Conclusion
The results of our meta-analysis suggest that postoperative adjuvant chemoradiotherapy in patients with head and neck cancer with adverse pathologic factors favors a superior survival and a better locoregional control compared to postoperative radiotherapy alone, despite not affecting the ocurrence of distant metastasis.
期刊介绍：
Brazilian Journal of Otorhinolaryngology publishes original contributions in otolaryngology and the associated areas (cranio-maxillo-facial surgery and phoniatrics). The aim of this journal is the national and international divulgation of the scientific production interesting to the otolaryngology, as well as the discussion, in editorials, of subjects of scientific, academic and professional relevance.
The Brazilian Journal of Otorhinolaryngology is born from the Revista Brasileira de Otorrinolaringologia, of which it is the English version, created and indexed by MEDLINE in 2005. It is the official scientific publication of the Brazilian Association of Otolaryngology and Cervicofacial Surgery. Its abbreviated title is Braz J Otorhinolaryngol., which should be used in bibliographies, footnotes and bibliographical references and strips.
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