内镜与颅面切除术治疗侵犯颅底鼻窦癌的匹配校正间接比较

IF 7.6 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2025-03-24 DOI:10.1016/j.ejca.2025.115382

Florian Chatelet , Sylvie Chevret , Alessandro Vinciguerra , Giacomo Bertazzoni , Domitille Camous , Marco Ferrari , Davide Mattavelli , Mario Turri-Zanoni , Alberto Schreiber , Stefano Taboni , Vittorio Rampinelli , Alberto Daniele Arosio , Cesare Piazza , Paolo Battaglia , Maurizio Bignami , Alberto Deganello , Paolo Castelnuovo , Piero Nicolai , Philippe Herman , Benjamin Verillaud

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引用次数: 0

摘要

本研究的目的是通过非锚定匹配调整间接比较（MAIC），比较内镜鼻内入路（EEA）与颅面切除术（CFR）治疗侵犯颅底的鼻窦癌的疗效和安全性。方法采用MAIC方法分析来自两个大队列的数据：内镜治疗鼻窦癌多机构合作研究（MUSES）队列，包括内镜治疗的鼻窦癌患者，以及Ganly等报道的历史CFR队列。只有第一组的个体患者数据可用。排除嗅觉神经母细胞瘤患者。使用关键预后因素来匹配和调整两个队列，最大限度地减少选择偏差。主要终点是总生存期（OS），次要终点包括无复发生存期（RFS）、围手术期死亡率、并发症发生率和切除边缘。结果eea治疗组724例，cfr治疗组334例。EEA调整前（HR= 2.33, 95 % CI= 1.88 ~ 2.87）和MAIC调整后（HR= 1.93, 95 % CI= 1.60 ~ 2.34） OS均有显著改善。观察到的RFS在EEA组较高（HR= 1.39, 95 % CI= 1.14-1.69），但调整后不再有差异（HR= 1.06, 95 % CI= 0.91-1.23）。与CFR相比，EEA具有更好的疾病特异性生存率（HR= 1.71, 95 % CI= 1.39-2.13）、更低的围手术期死亡率（OR= 8.12, 95 % CI= 3.45-36.7）和更少的并发症（OR= 3.68, 95 % CI= 2.47-5.42）。在这项基于2个最大的颅底侵犯鼻窦癌队列的MAIC研究中，EEA提供了与CFR相当的肿瘤结果，且发病率降低，支持其在专家中心作为有效的替代方案。

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Matching-adjusted indirect comparison of endoscopic and craniofacial resection for the treatment of sinonasal cancer invading the skull base

Aim

The aim of this study was to compare the efficacy and safety of endoscopic endonasal approaches (EEA) with craniofacial resection (CFR) for sinonasal cancers invading the skull base, using an unanchored matching-adjusted indirect comparison (MAIC).

Methods

A MAIC approach was used to analyse data from two large cohorts: the MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers (MUSES) cohort, comprising sinonasal cancer patients treated endoscopically, and a historical CFR cohort reported by Ganly et al. Individual patient data were available only for the first cohort. Patients with olfactory neuroblastomas were excluded. Key prognostic factors were used to match and adjust the two cohorts, minimising selection bias. The primary endpoint was overall survival (OS), with secondary endpoints including recurrence-free survival (RFS), perioperative mortality, complication rates, and resection margins.

Results

A total of 724 EEA-treated and 334 CFR-treated patients were included. EEA showed significantly improved OS before (HR= 2.33, 95 % CI= 1.88–2.87) and after MAIC adjustment (HR= 1.93, 95 % CI= 1.60–2.34). Observed RFS was higher in the EEA group (HR= 1.39, 95 % CI = 1.14–1.69) but no longer differed after adjustment (HR= 1.06, 95 % CI= 0.91–1.23). EEA was associated with significantly better Disease Specific Survival (HR= 1.71, 95 % CI = 1.39–2.13), lower perioperative mortality (OR= 8.12, 95 % CI= 3.45–36.7) and fewer complications than CFR (OR= 3.68, 95 % CI= 2.47–5.42).

Conclusion

In this MAIC study based on the 2 largest cohorts of sinonasal cancer with skull base invasion, EEA offered comparable oncologic outcomes to CFR with reduced morbidity, supporting it as a valid alternative when performed in expert centres.

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来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.