Armando De Virgilio, Giulio Pagliuca, Elena Russo, Erika Crosetti, Giovanni Motta, Giorgio Peretti, Antonio Greco, Giovanni Succo, Marco de Vincentiis, Andrea Gallo
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引用次数: 0
摘要
目的：探讨经口激光显微手术（TLM）治疗喉鳞癌（LSCC）患者手术切缘对预后的影响。方法：按照PRISMA指南，在PubMed/MEDLINE、Cochrane Library、Scopus和谷歌Scholar中进行全面的文献检索。比较阳性和阴性切除边缘的肿瘤预后的研究被纳入。提取局部对照（LC）、无病生存（DFS）和总生存（OS）的风险比（hr），并使用随机效应模型进行汇总，以解释研究间的可变性。结果：共有26项研究，5463例患者符合纳入标准。DFS的合并log-HR为0.93 (p < 0.05)，表明切缘阳性患者的复发风险显著增加。然而，LC （log-HR = -0.76, p = 0.59）和OS （log-HR = 0.16, p = 0.40）无显著差异。结论：虽然正切缘显著影响DFS，但其对LC和OS的影响仍不确定。需要进一步的前瞻性研究来完善治疗指南和优化肿瘤预后。
Prognostic significance of surgical margins in laryngeal cancer treated by transoral laser microsurgery: a systematic review and meta-analysis.
Objective: To evaluate the prognostic significance of surgical margins in patients undergoing transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (LSCC).
Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar following PRISMA guidelines. Studies comparing oncologic outcomes between positive and negative resection margins were included. Hazard ratios (HRs) for local control (LC), disease-free survival (DFS), and overall survival (OS) were extracted and pooled using a random-effects model to account for inter-study variability.
Results: A total of 26 studies, including 5,463 patients, met inclusion criteria. The pooled log-HR for DFS was 0.93 (p < 0.05), indicating a significantly higher risk of recurrence in patients with positive margins. However, no significant differences were observed for LC (log-HR = -0.76, p = 0.59) or OS (log-HR = 0.16, p = 0.40).
Conclusions: While positive surgical margins significantly impact DFS, their effect on LC and OS remains uncertain. Further prospective studies are necessary to refine treatment guidelines and optimise oncologic outcomes.
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.
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