Satar Bülent, Yetiser Sertaç, Ozkaptan Yalçin
KBB Anabilim Dali. Gülhane Askeri Tip Akademisi, Ankara, Turkey.
Acta Otolaryngol. 2003 May;123(4):499-505. doi: 10.1080/00016480310000566a.
The purpose of this study was to review the English language literature concerning the effect of tumor size on hearing outcome and facial function after the middle fossa approach for acoustic neuroma in a large patient population.
The literature search identified a total of 11 studies reporting hearing outcome and facial function for a given tumor size. There were 1073 and 797 cases available for the analysis of hearing outcome and facial function, respectively. These cases were subdivided based on the way in which tumor size was measured: category 1 considered only the extracanalicular portion of the tumor; and category 2 considered the largest diameter of the tumor. In category 1, hearing and facial results were regrouped based on tumor size as follows: intracanalicular (IC) tumors; 1-9 mm tumors; 10-20 mm tumors; and a combined group of < 0.5 mm tumors, including IC tumors. In category 2, tumors were subdivided into 2 groups: those < 10 mm in diameter; and those 10-20 mm in diameter. In each category, tumor size groups were compared using the chi2 test in terms of the rate of functional hearing preservation and good facial function.
In category 1, analysis of the rate of functional hearing preservation showed that IC tumors compared favorably with the 1-9 mm and 10-19 mm tumors (56.9% vs 45.6%, p = 0.016; and 56.9% vs 32.3%, p < 0.001, respectively). The IC tumor group had the best rate of good facial function, followed by the 1-9 mm and 10-19 mm tumors (98.9% vs 93.9%, p = 0.007: and 98.9% vs 85.6%, p < 0.001, respectively). In category 2, rates of functional hearing preservation and good facial function were almost the same for tumors < 10 mm in diameter and those 10-20 mm in diameter (p > 0.05).
The meta-analysis revealed that tumor size is an important variable determining hearing outcome and facial function. Inclusion of the IC portion of a tumor in the tumor size measurement apparently hampered the statistical power of the study, leading to an overestimation of the size of IC tumors.
本研究旨在回顾英文文献，探讨在大量患者中，经中颅窝入路切除听神经瘤时，肿瘤大小对听力结果和面部功能的影响。
文献检索共确定11项研究报告了特定肿瘤大小的听力结果和面部功能。分别有1073例和797例可用于听力结果和面部功能分析。这些病例根据肿瘤大小的测量方式进行细分：第1类仅考虑肿瘤的外耳道部分；第2类考虑肿瘤的最大直径。在第1类中，听力和面部结果根据肿瘤大小重新分组如下：内听道（IC）肿瘤；1 - 9毫米肿瘤；10 - 20毫米肿瘤；以及包括IC肿瘤在内的<0.5毫米肿瘤的组合组。在第2类中，肿瘤细分为2组：直径<10毫米的肿瘤；以及直径10 - 20毫米的肿瘤。在每一类中，使用卡方检验比较肿瘤大小组在功能性听力保留率和良好面部功能方面的差异。
在第1类中，功能性听力保留率分析显示，IC肿瘤与1 - 9毫米和10 - 19毫米肿瘤相比具有优势（分别为56.9%对45.6%，p = 0.016；以及56.9%对32.3%，p < 0.001）。IC肿瘤组的良好面部功能率最高，其次是1 - 9毫米和10 - 19毫米肿瘤（分别为98.9%对93.9%，p = 0.007；以及98.9%对85.6%，p < 0.001）。在第2类中，直径<10毫米的肿瘤和直径10 - 20毫米的肿瘤在功能性听力保留率和良好面部功能率方面几乎相同（p > 0.05）。
荟萃分析表明，肿瘤大小是决定听力结果和面部功能的重要变量。将肿瘤的IC部分纳入肿瘤大小测量显然削弱了研究的统计效力，导致对IC肿瘤大小的高估。
