Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma?
Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma?
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DOI：
10.1016/j.joms.2016.08.005
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发表时间：
2017-02-01
影响因子：
1.9
通讯作者：
Li, Longjiang
中科院分区：
文献类型：
--
作者：
Li, Chunjie;Lin, Jie;Li, Longjiang
目的：口腔鳞状细胞癌(OSCC)侵犯下颌骨是否可以作为肿瘤分期和预后预测的一个因素仍是一个有争议的话题。此外，不同类型的下颌骨侵犯(皮质或髓质侵犯)对患者预后的影响尚不清楚。这项系统性综述的目的是确定下颌骨侵袭或其亚组是否应该被认为是口腔鳞癌患者的独立预后因素。材料和方法：根据预先设计的纳入标准进行系统性综述，寻找符合条件的研究。下颌骨侵袭和侵袭深度分别被认为是主要和次要预测变量。使用12个数据库进行电子搜索。手工检索14种相关期刊，扫描纳入研究的参考文献。2名评价者使用Saltaji等人推荐的偏见风险评估工具(Angel Orthod 82：1115,2012)对偏见评估的风险进行了评估。两位评审员摘录了一式两份的数据。采用Revman 5.2软件进行Meta分析，评估主要预后(无病生存率和总生存率)和次要预后(2、5年生存率和局部控制率)。结果：共纳入18项研究，共3756人，作为研究样本。在这些纳入的研究中，7个有不清楚的偏向风险，其余的显示出高风险。Meta分析的结果显示，下颌骨侵犯与总存活率显著相关(P=.04)，最重要的是，髓质侵犯(P=.0001)而不是皮质侵犯(P=.66)会降低总存活率。当关注疾病特异性生存时，下颌髓质受累预示疾病特异性存活率较低(P<；.0001)，但皮质受累没有影响(P=.66)。
Purpose: Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of debate. In addition, the influence of different types of mandibular invasion (cortical or medullary invasion) on patients' prognosis remains unclear. The aim of this systematic review was to establish whether mandibular invasion or its subset should be considered an independent prognostic factor for patients with OSCC.Materials and Methods: The search for eligible studies was performed according to the predesigned inclusion criteria for a systematic review. Mandibular invasion and invasion depth were considered the primary and secondary predictor variables, respectively. The electronic search was performed using 12 databases. Manual searching covered 14 related journals and references of the included studies were scanned. The risk of bias assessment was evaluated by 2 reviewers using risk-of-bias assessment tools recommended by Saltaji et al (Angle Orthod 82:1115, 2012). Two reviewers extracted the data in duplicate. RevMan 5.2 was used for meta-analysis to assess the primary outcomes (disease-free survival and overall survival) and the secondary outcomes (2-and 5-year survival rate and local control).Results: Eighteen studies (total, 3,756 participants) were included and used as the study sample. Among these included studies, 7 had an unclear risk of bias and the remaining showed a high risk. The results of the meta-analyses showed a significant relation between mandibular invasion and overall survival (P = .04) and, most importantly, that medullary involvement (P = .0001), but not cortical involvement (P = .66), could decrease overall survival. When focusing on disease-specific survival, mandibular medullary involvement predicted a poor disease-specific survival (P < .0001), but cortical involvement showed no effect (P = .66).