University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkiye.
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Lariana, Como, Italy.
Oral Oncol. 2024 Dec;159:107048. doi: 10.1016/j.oraloncology.2024.107048. Epub 2024 Oct 2.
This systematic review evaluates the efficacy and morbidity of transnasal endoscopic nasopharyngectomy as a salvage treatment for advanced-stage recurrent nasopharyngeal carcinoma (rNPC).
Following PRISMA guidelines, we conducted a systematic search in Medline, Scopus, and PubMed, identifying studies on transnasal endoscopic nasopharyngectomy for rNPC. Inclusion criteria encompassed histologically confirmed rT3 and rT4 NPC patients previously treated with radiotherapy or chemoradiotherapy. Data on overall survival (OS), disease-free survival (DFS), and complications were extracted and analyzed.
Nine studies, including a total of 429 patients, met the inclusion criteria. Five studies reported 2-year overall survival (OS) rates ranging from 34.6 % to 88.7 %. Three studies reported 3-year OS rates between 50 % and 63.5 %. Long-term 5-year survival varied widely from 0 % to 100 % across three studies. One study detailed 1-year disease-free survival (DFS) and OS at 93 % and 98 %, respectively. The pooled analysis included 429 patients with a median follow-up of 26.1 months. Complications were predominantly minor and transient. Major complications included necrosis, hemorrhage, cranial nerve palsy, and death. Advanced surgical techniques and pre-treatment measures, such as internal carotid artery embolization, improved resection outcomes and reduced complication rates.
Transnasal endoscopic nasopharyngectomy emerges as a viable salvage option for advanced rNPC, offering favorable survival outcomes and manageable complication profiles. Future research should focus on refining surgical techniques and improving patient selection criteria to further enhance treatment efficacy.
本系统评价评估经鼻内镜鼻咽切除术作为晚期复发鼻咽癌（rNPC）挽救性治疗的疗效和发病率。
根据 PRISMA 指南，我们在 Medline、Scopus 和 PubMed 中进行了系统搜索，确定了经鼻内镜鼻咽切除术治疗 rNPC 的研究。纳入标准包括经组织学证实的先前接受过放疗或放化疗治疗的 rT3 和 rT4 NPC 患者。提取并分析总生存（OS）、无病生存（DFS）和并发症的数据。
共有 9 项研究，共 429 例患者符合纳入标准。5 项研究报告了 2 年总生存率（OS），范围从 34.6%到 88.7%。3 项研究报告了 3 年 OS 率在 50%至 63.5%之间。3 项研究中，长期 5 年生存率从 0%到 100%不等。1 项研究详细报告了 1 年无病生存率（DFS）和 OS 分别为 93%和 98%。荟萃分析纳入了 429 例患者，中位随访时间为 26.1 个月。并发症主要为轻微和短暂。主要并发症包括坏死、出血、颅神经麻痹和死亡。先进的手术技术和预处理措施，如颈内动脉栓塞，改善了切除结果并降低了并发症发生率。
经鼻内镜鼻咽切除术是晚期 rNPC 的一种可行的挽救性治疗选择，可获得良好的生存结果和可管理的并发症。未来的研究应侧重于完善手术技术和改善患者选择标准，以进一步提高治疗效果。
