Gou L, Yang W, Qiao X, Ye L, Yan K, Li L, Li C
Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
Int J Oral Maxillofac Surg. 2018 Jan;47(1):1-10. doi: 10.1016/j.ijom.2017.07.019. Epub 2017 Aug 18.
Surgery is the most well established mode of initial definitive treatment for the majority of oral cancers. The most important decision in terms of tumour ablation in oral cancers when the jaws are potentially involved is the management of the mandible. The aim of this study was to explore the differences in survival rate and disease control between patients undergoing marginal mandibulectomy and patients undergoing segmental mandibulectomy using a systematic review and meta-analysis approach. A total of 15 cohort studies, including 1672 participants, were identified. Meta-analysis provided weak evidence in favour of segmental mandibulectomy for local control. Segmental mandibulectomy gave 73% better disease-free survival than marginal mandibulectomy when the marrow was invaded (P=0.04). The overall survival rate was evaluated, and no statistically significant difference was found between the two different mandibulectomy approaches, although the results showed a trend in favour of segmental mandibulectomy which could increase the overall survival by 23%. Based on these findings regarding the survival rate and efficacy of disease control, this study indicates that a marginal mandibulectomy may be recommended for cases with no invasion or superficial invasion of the mandibular cortex, and a segmental mandibulectomy may be a more reasonable choice for patients with extensive mandibular cortex invasion or medullary invasion.
对于大多数口腔癌而言，手术是最成熟的初始确定性治疗方式。在口腔癌累及颌骨时，就肿瘤切除而言，最重要的决策是下颌骨的处理。本研究的目的是采用系统评价和荟萃分析方法，探讨接受边缘性下颌骨切除术的患者与接受节段性下颌骨切除术的患者在生存率和疾病控制方面的差异。共纳入15项队列研究，包括1672名参与者。荟萃分析提供了微弱证据，支持节段性下颌骨切除术用于局部控制。当骨髓受侵时，节段性下颌骨切除术的无病生存率比边缘性下颌骨切除术高73%（P = 0.04）。评估了总生存率，两种不同的下颌骨切除术方法之间未发现统计学上的显著差异，尽管结果显示出倾向于节段性下颌骨切除术的趋势，其可使总生存率提高23%。基于这些关于生存率和疾病控制疗效的研究结果，本研究表明，对于下颌骨皮质无侵犯或浅表侵犯的病例，可推荐边缘性下颌骨切除术；对于下颌骨皮质广泛侵犯或骨髓侵犯的患者，节段性下颌骨切除术可能是更合理的选择。
