Goh Ruth S, Keng Christopher Goh Hood
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
Otolaryngology, Head and Neck Surgery, Duke-NUS Medical School, Singapore.
J Rhinol. 2025 Mar;32(1):10-16. doi: 10.18787/jr.2025.00001. Epub 2025 Mar 21.
Malignant neoplasms of the nasal cavity and paranasal sinuses are an aggressive form of tumour that tends to be diagnosed at a locoregionally advanced stage. Among its various histological subtypes, squamous cell carcinomas (SCC) are the most common form of sinonasal cancer, with approximately 50%-60% of sinonasal malignancies being SCC. This review aims to investigate the impact of induction chemotherapy on survival outcomes for patients undergoing cancer care for sinonasal squamous cell carcinomas (SNSCC).
Two reviewers independently assessed 2,118 studies pooled from four bibliographic databases, namely MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science and hand-searched grey literature. This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. As this was a time-to-event analysis, hazard ratios (HRs) and standard errors were derived from individual studies and pooled together for analysis. If these values were not available directly, statistical methods were used to indirectly extract the required data via Kaplan-Meier curves or via the p-value and the numbers of events.
Results suggest a notable improvement in overall survival (HR=0.56, 95% confidence interval [CI]=[0.36, 0.86], p<0.009) and a promising improvement in disease-free survival (HR=0.82, 95% CI=[0.62, 1.08], p=0.16) for patients who underwent induction chemotherapy in addition to definitive treatment for SNSCC.
Our findings add to existing literature by providing a precise pooled estimate of the beneficial effects, revealing that induction chemotherapy is not just a viable add-on to traditional treatment regimens but also improves survival outcomes when compared to definitive local therapy as a standalone treatment. Clinicians should consider incorporating induction chemotherapy as a treatment option for locoregionally advanced SNSCC.
鼻腔及鼻窦恶性肿瘤是一种侵袭性肿瘤，往往在局部区域晚期才被诊断出来。在其各种组织学亚型中，鳞状细胞癌（SCC）是鼻窦癌最常见的形式，约50%-60%的鼻窦恶性肿瘤为SCC。本综述旨在研究诱导化疗对鼻窦鳞状细胞癌（SNSCC）患者癌症治疗生存结局的影响。
两名综述员独立评估了从四个文献数据库（即MEDLINE、Embase、Cochrane对照试验中央注册库和科学网）汇总的2118项研究，并手工检索了灰色文献。本系统综述和荟萃分析按照系统综述和荟萃分析的首选报告项目（PRISMA）指南进行。由于这是一项事件发生时间分析，风险比（HRs）和标准误差从各个研究中得出并汇总进行分析。如果这些值不能直接获得，则使用统计方法通过Kaplan-Meier曲线或通过p值和事件数间接提取所需数据。
结果表明，对于接受诱导化疗加SNSCC确定性治疗的患者，总生存率有显著提高（HR=0.56，95%置信区间[CI]=[0.36, 0.86]，p<0.009），无病生存率也有有望提高（HR=0.82，95%CI=[0.62, 1.08]，p=0.16）。
我们的研究结果通过提供有益效果的精确汇总估计，为现有文献增添了内容，表明诱导化疗不仅是传统治疗方案可行的附加治疗，而且与作为单一治疗的确定性局部治疗相比，还能改善生存结局。临床医生应考虑将诱导化疗作为局部区域晚期SNSCC的一种治疗选择。
