Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Endoscopic Sinus, and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
Int Forum Allergy Rhinol. 2011 Jul-Aug;1(4):255-61. doi: 10.1002/alr.20051. Epub 2011 May 9.
Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled-data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies.
A search was conducted of MEDLINE (1966-2008), EMBASE (1980-2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases and supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, sinonasal malignancy characteristics, survival outcomes, and recurrence. Kaplan-Meier survival and locoregional control rates were calculated and compared using the log-rank test.
Of the 2314 citations reviewed, the search yielded 15 case series with individual data on 226 patients. The most common malignancies were esthesioneuroblastoma (47%), adenocarcinoma (24%), and undifferentiated carcinoma (22%). The overall 5-year survival rate for the sample was 56.5% (standard error [SE] ± 3.8). Because of the paucity of data with endoscopic resection of high-stage malignancies, the outcome results were highly variable and no useful comparison could be made. Among low-stage malignancies (T1-2 or Kadish A-B), the endoscopic and open approaches demonstrated no statistically significant difference in outcome results. The 5-year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs 76.8% (SE ± 8.3) for open approaches (p = 0.351); disease-specific survival was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251).
Transnasal endoscopic resection appears to be a reasonable alternative to craniofacial resection in the management of low-stage sinonasal malignancies.
目前已经有关于鼻内镜入路治疗鼻窦恶性肿瘤的描述。本研究旨在进行系统评价和汇总数据分析，以比较内镜手术与颅面联合切除术治疗鼻窦恶性肿瘤的结果。
检索 MEDLINE（1966-2008 年）、EMBASE（1980-2008 年）、Cochrane 临床试验中心注册库（CENTRAL）、Cochrane 系统评价数据库、ClinicalTrials.gov 和美国国立指南库（National Guideline Clearinghouse）数据库，并对检索文章中的参考文献进行补充。所有作者都使用详细的纳入和排除标准列表来确定最终纳入的文章。作者提取了关于研究标准评估、鼻窦恶性肿瘤特征、生存结果和复发的数据。使用对数秩检验计算并比较 Kaplan-Meier 生存和局部区域控制率。
在 2314 篇引用文献中，通过搜索得到了 15 篇病例系列研究，其中包括 226 例患者的个体数据。最常见的恶性肿瘤为嗅神经母细胞瘤（47%）、腺癌（24%）和未分化癌（22%）。该样本的 5 年总生存率为 56.5%（标准误差 [SE] ± 3.8）。由于内镜下治疗高分期恶性肿瘤的数据很少，因此结果差异很大，无法进行有用的比较。在低分期恶性肿瘤（T1-2 或 Kadish A-B）中，内镜和开放手术在结果上无统计学差异。内镜组的 5 年总生存率为 87.4%（SE ± 5.3），开放组为 76.8%（SE ± 8.3）（p = 0.351）；疾病特异性生存率为 94.7%（SE ± 3.7）vs 87.7%（SE ± 6.7；p = 0.258）；局部区域控制率为 89.5%（SE ± 5.0）vs 77.2%（SE ± 10.4；p = 0.251）。
经鼻内镜切除术似乎是治疗低分期鼻窦恶性肿瘤的一种合理选择，可替代颅面联合切除术。
