De Virgilio Armando, Pagliuca Giulio, Russo Elena, Crosetti Erika, Motta Giovanni, Peretti Giorgio, Greco Antonio, Succo Giovanni, de Vincentiis Marco, Gallo Andrea
Department of Sense Organs, Sapienza University of Rome, Italy.
Otorhinolaryngology University Unit, "S.M. Goretti Hospital", Latina, Italy.
Acta Otorhinolaryngol Ital. 2025 May;45(Suppl. 1):S71-S86. doi: 10.14639/0392-100X-suppl.1-45-2025-N1142.
To evaluate the prognostic significance of surgical margins in patients undergoing transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (LSCC).
A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar following PRISMA guidelines. Studies comparing oncologic outcomes between positive and negative resection margins were included. Hazard ratios (HRs) for local control (LC), disease-free survival (DFS), and overall survival (OS) were extracted and pooled using a random-effects model to account for inter-study variability.
A total of 26 studies, including 5,463 patients, met inclusion criteria. The pooled log-HR for DFS was 0.93 (p < 0.05), indicating a significantly higher risk of recurrence in patients with positive margins. However, no significant differences were observed for LC (log-HR = -0.76, p = 0.59) or OS (log-HR = 0.16, p = 0.40).
While positive surgical margins significantly impact DFS, their effect on LC and OS remains uncertain. Further prospective studies are necessary to refine treatment guidelines and optimise oncologic outcomes.
评估接受经口激光显微手术（TLM）治疗喉鳞状细胞癌（LSCC）患者手术切缘的预后意义。
按照PRISMA指南在PubMed/MEDLINE、Cochrane图书馆、Scopus和谷歌学术进行全面的文献检索。纳入比较阳性和阴性切除切缘肿瘤学结局的研究。提取局部控制（LC）、无病生存（DFS）和总生存（OS）的风险比（HRs），并使用随机效应模型进行汇总以考虑研究间的变异性。
共有26项研究，包括5463例患者，符合纳入标准。DFS的汇总对数HR为0.93（p<0.05），表明切缘阳性患者复发风险显著更高。然而，LC（对数HR=-0.76，p=0.59）或OS（对数HR=0.16，p=0.40）未观察到显著差异。
虽然阳性手术切缘对DFS有显著影响，但其对LC和OS的影响仍不确定。需要进一步的前瞻性研究来完善治疗指南并优化肿瘤学结局。
