Margins in oncologic nasopharyngeal surgery: a systematic review with 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-N1170

Antonio Daloiso, Piergiorgio Gaudioso, Alessandro Vinciguerra, Stefano Taboni, Paolo Castelnuovo, Piero Nicolai, Mario Turri-Zanoni, Marco Ferrari, Paolo Battaglia

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引用次数: 0

Abstract

Objective: Nasopharyngeal malignancies are rare heterogenous histologies (nasopharyngeal carcinoma [NPC], minor salivary glands carcinomas, and low-grade papillary nasopharyngeal adenocarcinoma) and a significant proportion of patients experience loco-regional recurrence after primary treatment. Resection margin status is a key prognostic factor that influences recurrence and survival, although definitions and criteria for negative, close, and positive margins remain inconsistent. This systematic review with meta-analysis aimed to summarise the existing definitions of resection margins in the literature and evaluate their impact on clinical outcomes in patients undergoing nasopharyngectomy with a specific focus on NPC.

Methods: A systematic literature review was conducted according to PRISMA guidelines. Electronic databases (Scopus, PubMed, and Web of Science) were searched up to November 2024. Studies reporting on surgical margins and survival outcomes in patients with NPC treated with endoscopic or open nasopharyngectomy were included. Pooled odds ratios (OR) for overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were calculated using a random-effects model.

Results: A total of 45 studies met the inclusion criteria, with 12 included in the meta-analysis. Positive surgical margins were associated with worse 5-year DFS (OR 2.21, 95% CI 1.55-3.14, p < 0.001), while no significant impact was observed on 3-year DFS (OR 2.3, p = 0.239), 3-year OS (OR 2, p = 0.167), 5-year OS (OR 2.98, p = 0.115), 3-year DSS (OR 1.25, p = 0.761), or 5-year DSS (OR 2.57, p = 0.265). Margin positivity rates were 16.9% for endoscopically-treated NPC, 20.6% for open-surgery NPC, and 20.6% for mixed histology, with no significant difference between surgical approaches (p = 0.995).

Conclusions: Positive resection margins significantly impact DFS in recurrent NPC. Standardised margin definitions are needed to improve prognostication and guide decisions on adjuvant therapy.

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肿瘤学鼻咽手术的边缘：一项系统综述和荟萃分析。

目的：鼻咽恶性肿瘤是一种罕见的异质组织学（鼻咽癌、小涎腺癌和低级别乳头状鼻咽腺癌），有相当比例的患者在初次治疗后出现局部区域复发。切除切缘状态是影响复发和生存的关键预后因素，尽管阴性、接近和阳性切缘的定义和标准仍不一致。本系统综述与荟萃分析旨在总结文献中切除边缘的现有定义，并评估其对鼻咽癌切除术患者临床结果的影响。方法：根据PRISMA指南进行系统的文献回顾。检索截止到2024年11月的电子数据库（Scopus、PubMed和Web of Science）。研究报告了鼻咽癌患者行内镜或开放式鼻咽切除术的手术边缘和生存结果。使用随机效应模型计算总生存期（OS）、疾病特异性生存期（DSS）和无病生存期（DFS）的合并优势比（OR）。结果：共有45项研究符合纳入标准，其中12项纳入meta分析。手术切缘阳性与较差的5年DFS相关（OR 2.21, 95% CI 1.55-3.14, p < 0.001），而对3年DFS （OR 2.3, p = 0.239）、3年OS （OR 2, p = 0.167）、5年OS （OR 2.98, p = 0.115）、3年DSS （OR 1.25, p = 0.761）、5年DSS （OR 2.57, p = 0.265）无显著影响。内镜下鼻咽癌切缘阳性率为16.9%，开放性鼻咽癌为20.6%，混合组织学鼻咽癌为20.6%，手术入路间差异无统计学意义（p = 0.995）。结论：阳性切缘对复发性鼻咽癌患者的DFS有显著影响。需要标准化的切缘定义来改善预后和指导辅助治疗的决策。

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.