Surgical margin assessment and prognostic impact in sinonasal cancers: a systematic review and meta-analysis.

IF 2.1 4区医学 Q2 OTORHINOLARYNGOLOGY

Acta Otorhinolaryngologica Italica Pub Date : 2025-05-01 DOI:10.14639/0392-100X-suppl.1-45-2025-N1127

Alberto Daniele Arosio, Elisa Coden, Alessia Lambertoni, Giorgio Sileo, Gianluca Dalfino, Giulia Monti, Antonio Daloiso, Piergiorgio Gaudioso, Marco Ferrari, Piero Nicolai, Paolo Castelnuovo, Maurizio Bignami

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Abstract

Objective: Surgery remains a cornerstone in treatment of sinonasal malignancies, but the prognostic role of margin status is controversial. This systematic review and meta-analysis evaluated the prognostic significance of surgical margins in sinonasal cancer and their impact on survival, alongside key challenges in its evaluation.

Methods: A systematic search in PubMed, Scopus, and Web of Science identified 64 studies (34,120 patients).

Results: The overall margin infiltration rate was 33.2%, varying widely across studies (4.5-88.2%) and histotypes, and was the highest in adenoid cystic carcinoma (ACC, 61.5%). Meta-analysis of 31 studies showed positive margins were associated with worse survival (overall survival, odds ratio [OR] 2.61; disease-specific survival, OR 5.89; disease-free survival, OR 4.40). Squamous cell carcinoma, olfactory neuroblastoma, and mucosal melanoma had the strongest correlation with margin status, while for ACC and adenocarcinomas statistical significance was not reached. High heterogeneity was noted across studies, alongside inconsistent margin classification, distance thresholds, and use of frozen sections, limiting cross-study comparability.

Conclusions: This study confirms the prognostic value of surgical margins, but underscores the urgent need for standardised definitions to improve prediction of oncologic outcomes and clinical decision-making.

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鼻窦癌手术切缘评估和预后影响：系统回顾和荟萃分析。

目的：手术仍然是鼻窦恶性肿瘤治疗的基石，但切缘状态的预后作用是有争议的。本系统综述和荟萃分析评估了鼻窦癌手术切缘的预后意义及其对生存的影响，以及评估中的关键挑战。方法：在PubMed， Scopus和Web of Science中进行系统搜索，确定了64项研究（34120例患者）。结果：总体切缘浸润率为33.2%，不同研究（4.5-88.2%）和组织类型差异很大，其中腺样囊性癌最高（ACC, 61.5%）。31项研究的荟萃分析显示，阳性切缘与较差的生存相关(总生存，优势比[OR] 2.61；疾病特异性生存，OR 5.89；无病生存率（OR 4.40）。鳞状细胞癌、嗅觉神经母细胞瘤和粘膜黑色素瘤与切缘状态的相关性最强，而ACC和腺癌的相关性无统计学意义。各研究之间存在高度异质性，同时存在不一致的边缘分类、距离阈值和冷冻切片的使用，限制了交叉研究的可比性。结论：本研究证实了手术切缘的预后价值，但强调了对标准化定义的迫切需要，以提高肿瘤预后的预测和临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Otorhinolaryngologica Italica OTORHINOLARYNGOLOGY-

CiteScore

3.40

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Acta Otorhinolaryngologica Italica first appeared as “Annali di Laringologia Otologia e Faringologia” and was founded in 1901 by Giulio Masini. It is the official publication of the Italian Hospital Otology Association (A.O.O.I.) and, since 1976, also of the Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale (S.I.O.Ch.C.-F.). The journal publishes original articles (clinical trials, cohort studies, case-control studies, cross-sectional surveys, and diagnostic test assessments) of interest in the field of otorhinolaryngology as well as clinical techniques and technology (a short report of unique or original methods for surgical techniques, medical management or new devices or technology), editorials (including editorial guests – special contribution) and letters to the Editor-in-Chief. Articles concerning science investigations and well prepared systematic reviews (including meta-analyses) on themes related to basic science, clinical otorhinolaryngology and head and neck surgery have high priority.