Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
Department of Experimental Center, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
Int Forum Allergy Rhinol. 2020 Aug;10(8):1001-1011. doi: 10.1002/alr.22552. Epub 2020 May 25.
Recurrent nasopharyngeal carcinoma (rNPC) is mainly managed with re-irradiation or salvage surgery. Endoscopic resection is generally considered as the preferred surgical treatment, whereas a standard treatment modality has yet to be established. This article is aimed to summarize the treatment outcomes of endoscopic rNPC resection.
Major medical databases including PubMed, EMBASE, Cochrane Central Library, Web of Science, and 2 major Chinese databases, CNKI and Wanfang, were searched for studies on endoscopic rNPC resection. Main characteristics of study and outcomes of interest were retrieved from articles meeting the selection criteria for meta-analysis.
A total of 761 articles were identified through the initial systematic research. The combined 1-year, 2-year, and 5-year overall survival (OS) rates were 97%, 92%, and 73% with random effect model, respectively. The combined 2-year and 5-year disease-free survival (DFS) rates were 81% and 62%, respectively. Meta-regression analysis showed that high recurrent tumor (rT) stage (rT3 to rT4) case proportion was a correlative factor of heterogeneity. Combined 2-year OS rate in rT1, rT2, rT3, and rT4 patients were 100%, 87%, 78%, and 38%, respectively. Combined 2-year DFS rate in rT1 and rT2 patients were and 96% and 86%, respectively.
The combined OS and DFS rates of rNPC patients treated with endoscopic nasopharyngectomy were summarized and reported in our study. This meta-analysis indicated that endoscopic nasopharyngectomy has comparable and possibly better treatment outcomes than intensity-modulated radiotherapy (IMRT). Therefore, the result of our study indicated that randomized controlled trials (RCTs) are needed in rNPC patients to compare treatment outcomes of endoscopic nasopharyngectomy vs IMRT.
复发性鼻咽癌（rNPC）主要通过再放疗或挽救性手术进行治疗。内镜切除通常被认为是首选的手术治疗方法，但是尚未建立标准的治疗方式。本文旨在总结内镜 rNPC 切除的治疗效果。
通过检索 PubMed、EMBASE、Cochrane 中央图书馆、Web of Science 和 2 个主要中文数据库（CNKI 和万方）等主要医学数据库，对符合荟萃分析纳入标准的内镜 rNPC 切除术研究进行文献筛选。提取文献的主要特征和感兴趣的结局。
通过初步系统研究共确定了 761 篇文章。采用随机效应模型，合并的 1 年、2 年和 5 年总生存率（OS）分别为 97%、92%和 73%。合并的 2 年和 5 年无疾病生存率（DFS）分别为 81%和 62%。Meta 回归分析显示，高复发肿瘤（rT）分期（rT3 至 rT4）患者比例是异质性的相关因素。rT1、rT2、rT3 和 rT4 患者的 2 年 OS 率分别为 100%、87%、78%和 38%。rT1 和 rT2 患者的 2 年 DFS 率分别为 96%和 86%。
本研究总结并报告了接受内镜鼻咽切除术的 rNPC 患者的 OS 和 DFS 综合结果。该荟萃分析表明，内镜鼻咽切除术与调强放疗（IMRT）的治疗效果相当，甚至可能更好。因此，我们的研究结果表明，需要在 rNPC 患者中进行随机对照试验（RCT），以比较内镜鼻咽切除术与 IMRT 的治疗效果。
