Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2021 Apr;164(4):733-740. doi: 10.1177/0194599820951175. Epub 2020 Sep 15.
To systematically review the literature to determine the prevalence and clinical outcomes of second primary oropharyngeal squamous cell carcinoma (OPSCC).
Search strategies created with a medical librarian were implemented using multiple databases in October 2019.
The population of interest included adults age >18 years with a p16+ or human papillomavirus-positive OPSCC. The outcome was a synchronous or metachronous second primary OPSCC. Inclusion and exclusion criteria were designed to capture all study designs. In total, 685 records were identified by the search strategy. Two reviewers independently performed the review, extracted data, and performed a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A random-effects model was used for the meta-analysis.
A total of 2470 patients with 35 second primary OPSCCs from 15 studies were identified. The pooled prevalence of second primary OPSCC was 1.4% (range, 0%-14.3%). In the random-effects model, the prevalence was estimated at 1.3% (95% CI, 0.7%-2.3%; = .51, = 52%). Of the 30 patients with treatment information, 26 (86.7%) received surgical treatment, while 4 (13.3%) underwent nonsurgical therapy. Of the 29 patients with available survival information, 22 (75.9%) had no evidence of disease at last follow-up, 5 (17.2%) ultimately died of disease, and 2 (6.9%) were alive with disease.
Overall, the rate of second primary OPSCC in patients with an index p16+ OPSCC is low, and most patients are successfully treated. Insufficient evidence currently exists to recommend routine elective tonsillectomy during surgical treatment of p16+ OPSCC.
系统综述文献，以确定第二原发或口咽鳞状细胞癌（OPSCC）的患病率和临床结局。
2019 年 10 月，与医学图书馆员合作制定的检索策略，利用多个数据库进行检索。
感兴趣的人群包括年龄> 18 岁的 p16+或人乳头瘤病毒阳性 OPSCC 成人。结局是同步或异时性第二原发 OPSCC。纳入和排除标准旨在捕获所有研究设计。共通过检索策略确定了 685 条记录。两名评审员独立进行了审查、提取数据并进行了质量评估。采用随机效应模型进行荟萃分析。
从 15 项研究中确定了 2470 例患者中有 35 例第二原发 OPSCC。第二原发 OPSCC 的总患病率为 1.4%（范围，0%-14.3%）。在随机效应模型中，患病率估计为 1.3%（95%CI，0.7%-2.3%； =.51， = 52%）。在 30 例有治疗信息的患者中，26 例（86.7%）接受了手术治疗，而 4 例（13.3%）接受了非手术治疗。在 29 例有生存信息的患者中，22 例（75.9%）在最后一次随访时无疾病证据，5 例（17.2%）最终死于疾病，2 例（6.9%）患有疾病仍存活。
总体而言，p16+ OPSCC 患者第二原发 OPSCC 的发生率较低，大多数患者得到了成功治疗。目前尚无足够证据推荐在 p16+ OPSCC 的手术治疗中常规选择性扁桃体切除术。
