Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Otolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore.
Clin Otolaryngol. 2024 Jan;49(1):29-40. doi: 10.1111/coa.14100. Epub 2023 Oct 20.
Sinonasal undifferentiated carcinoma (SNUC) is a rare but aggressive tumour with very poor prognosis. There are currently no well-established clinical trials to guide therapy and the impact of various treatment modalities on survival is not well defined. We aim to provide an updated systematic review on current treatment modalities on survival outcomes.
Individual patient data were extracted, and survival data pooled in a one-stage meta-analysis. Descriptive statistics were analysed using the Kaplan-Meier method. Patient-level comparisons stratified by treatment modalities, adjusted for demographics, were conducted using shared-frailty Cox regression.
Participants include all patients diagnosed with SNUC based on histological evidence. We looked at the overall cumulative survival outcome for different treatment modalities and overall survival by treatment modality in low versus high stage SNUC patients.
Seventeen studies were identified, comprising 208 patients from 1993 to 2020. There was no significant difference in cumulative overall survival in low versus high stage patients, and no significant difference in outcomes by treatment modality. The overall cumulative survival of SNUC is 30% at 95 months. Among patients treated with various combinations of treatment modalities, patients with chemoradiotherapy had the highest cumulative survival of 42% at 40 months. Definitive chemoradiotherapy was associated with improved disease survival rate. Regardless of tumour stage, patients should be treated early and aggressively, with no superiority of one treatment regimen over another. Trimodality treatment does not confer survival advantage over bimodality treatment.
鼻腔鼻窦未分化癌（SNUC）是一种罕见但侵袭性很强的肿瘤，预后极差。目前尚无完善的临床试验来指导治疗，不同治疗方式对生存的影响也不明确。我们旨在提供一份关于目前治疗方式对生存结果影响的最新系统评价。
提取个体患者数据，并在单阶段荟萃分析中汇总生存数据。使用 Kaplan-Meier 方法对描述性统计数据进行分析。使用共享脆弱性 Cox 回归对按治疗方式分层、按人口统计学因素调整的患者水平进行比较。
参与者包括所有根据组织学证据诊断为 SNUC 的患者。我们观察了不同治疗方式的总体累积生存率以及低分期与高分期 SNUC 患者的治疗方式的总体生存率。
共确定了 17 项研究，纳入了 1993 年至 2020 年间的 208 例患者。低分期与高分期患者的累积总体生存率无显著差异，不同治疗方式的结果也无显著差异。SNUC 的总体累积生存率为 95 个月时的 30%。在接受各种治疗方式联合治疗的患者中，接受放化疗的患者 40 个月时的累积生存率最高，为 42%。明确的放化疗可提高疾病生存率。无论肿瘤分期如何，患者都应尽早积极治疗，一种治疗方案并不优于另一种。三联疗法并不比双模态疗法具有生存优势。
