Devaiah Anand K, Andreoli Michael T
Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Laryngoscope. 2009 Jul;119(7):1412-6. doi: 10.1002/lary.20280.
OBJECTIVES/HYPOTHESIS: This study reviews the published outcomes related to surgical (open, endoscopic, and endoscopic-assisted) and nonsurgical treatment for esthesioneuroblastoma. STUDY DESIGN: Literature meta-analysis. METHODS: A meta-analysis of individual patient data for esthesioneuroblastoma publications between 1992 (the earliest identified description of endoscopic resection) and 2008 was conducted. A total of 49 journal articles, comprising 1,170 cases of esthesioneuroblastoma, were included in the study. Criteria for meta-analysis inclusion were five or more patients in a study with sufficient patient data resolution for analysis. Twenty-three studies comprising 361 patients met all inclusion criteria. The overall treatment and outcome at final follow-up of each patient was recorded. Patients were pooled according to treatment techniques and compared to one another using a Kaplan-Meier survival curve and the Mann-Whitney U test to examine differences in follow-up times and publication years. RESULTS: Log-rank tests showed a greater published survival rate for endoscopic surgery compared to open surgery (P = .0019), even when stratifying for publication year (P = .0018). There was no significant difference in follow-up time. Review of Kadish tumor staging for each modality showed larger tumors were more often treated with an open approach, but open and endoscopic survival measures were comparable. CONCLUSIONS: These results suggest that endoscopic surgery is a valid treatment method with comparable survival to open surgery. Further prospective analysis will be beneficial.
目的/假设:本研究回顾了与嗅神经母细胞瘤的手术治疗(开放手术、内镜手术和内镜辅助手术)及非手术治疗相关的已发表结果。 研究设计:文献荟萃分析。 方法:对1992年(最早确定的内镜切除术描述)至2008年间发表的嗅神经母细胞瘤相关文献进行个体患者数据的荟萃分析。该研究共纳入49篇期刊文章,包含1170例嗅神经母细胞瘤病例。荟萃分析纳入标准为研究中至少有5例患者且患者数据分辨率足以进行分析。23项研究共361例患者符合所有纳入标准。记录了每位患者最终随访时的总体治疗情况及结果。根据治疗技术将患者分组,使用Kaplan-Meier生存曲线和Mann-Whitney U检验相互比较,以检验随访时间和发表年份的差异。 结果:对数秩检验显示,与开放手术相比,内镜手术的发表生存率更高(P = 0.0019),即使按发表年份分层时也是如此(P = 0.0018)。随访时间无显著差异。对每种治疗方式的Kadish肿瘤分期进行回顾发现,较大的肿瘤更常采用开放手术治疗,但开放手术和内镜手术的生存指标相当。 结论:这些结果表明,内镜手术是一种有效的治疗方法,其生存率与开放手术相当。进一步的前瞻性分析将有益处。
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