临床关节阴性早期口腔癌的管理:随机临床试验的网络元分析
E A Al-Moraissi1, A S Alkhutari1, R de Bree2
1Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
International journal of oral and maxillofacial surgery
|September 4, 2023
概括
选择性部剖析 (END) 可能是临床结节阴性部的早期口腔状细胞癌 (OSCC) 的最佳治疗方法,与治疗性部剖析 (TND) 相比,提供更好的生存率和减少复发率. 哨兵淋巴结活检 (SLNB) 显示了与END相似的结果,但需要进一步研究.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 头部和部手术 头部和部手术
背景情况:
- 在早期口腔状细胞癌 (OSCC) 中,临床上阴性节点 (cN0) 部的最佳管理缺乏共识.
- 现有的治疗方案包括治疗性部剖析 (TND),哨兵淋巴结活检 (SLNB) 和选择性部剖析 (END).
研究的目的:
- 对随机临床试验 (RCT) 进行网络元分析 (NMA),以确定早期OSCC中cN0部最有效的治疗方法.
- 根据总生存率 (OS),疾病特异性生存率 (DSS),无疾病生存率 (DFS) 和结节复发的有效性来对治疗进行排名.
主要方法:
- 遵循PRISMA指南的系统文献搜索确定了相关的RCT,比较TND,SLNB和END.
- 进行了直接的元分析和NMA,以计算关键结果的危险比率和风险比率.
- 分析中包括了10个涉及1858名患者的RCT.
主要成果:
- 直接的元分析表明,END优于TND,与SLNB可比.
- 在OS,DSS,DFS和节点复发方面,NMA没有显示END和SLNB之间的显著差异 (质量非常低的证据).
- 与TND (中等质量的证据) 相比,END显著改善了OS和DFS,并减少了节点复发. END排名最高,其次是SLNB和TND.
结论:
- 选择性部剖析 (END) 是早期OSCC中cN0部的有利治疗方法,得到中等质量的证据支持.
- 哨兵淋巴结活检 (SLNB) 是有前途的,但需要进行更广泛的研究,特别是在检测逆侧转移的有效性及其长期结果方面.
- 需要进一步的研究来比较患病率,生活质量和与早期OSCC不同部管理策略相关的成本.
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