手术加辅助放疗与单纯手术两种治疗策略对头颈部黏膜恶性黑色素瘤预后影响的Meta分析

Prognosis of head and neck mucosal melanoma with surgical treament combined with adjuvant radiotherapy versus surgery alone:a Meta-analysis

目的对比分析手术加辅助放疗与单纯手术对头颈部黏膜恶性黑色素瘤预后的影响。方法全面检索万方全文数据库、CNKI数据库、MEDLINE、Cochrane Library等数据库收录的文献,对符合入选标准的文献提取数据进行Meta分析。结果共纳入11项研究,涉及3 211例患者。手术加辅助放疗与单纯手术相比,可以获得更好的局部控制(HR=0.35,95%CI=0.24-0.50;Z=5.64,P<0.001),但不能使总体生存获益(HR=1.07,95%CI=0.98-1.16;Z=1.43,P=0.15),也不能降低远处转移的风险(HR=2.59,95%CI=1.20-5.61;Z=2.41,P=0.02)。亚组分析显示:在头颈部黏膜恶性黑色素瘤(SNMM)患者中,手术加辅助放疗同样不能降低死亡的风险(HR=1.10,95%CI=0.86-1.43;Z=0.77,P=0.44);手术加术后放疗与单纯手术相比,总体生存相似(HR=1.12,95%CI=0.81-1.55;Z=0.70,P=0.48)。结论手术加辅助放疗可以实现更好的局部控制,但不能使生存获益,目前仍需要高质量临床研究探索其确切疗效。但是由于头颈部解剖结构复杂,应积极采用辅助放疗技术控制局部病变的复发,并辅以全身治疗,以期更好的生存获益。

Objective To compare the effect of surgery combined with adjuvant radiotherapy and surgery alone on the prognosis of head and neck mucosal melanoma(HNMM).Methods An comprehensive search of the literature was performed in electronic databases(Wanfang, CNKI, MEDLINE, Cochrane Library) and a Meta analysis of acquired data that conform to the inclusion criteria was performed.Results A total of 11 studies were enrolled, in which 3 211 patients were included. Compared with surgery alone, surgery combined with adjuvant radiotherapy could achieve better local control(HR=0.35, 95%CI=0.24-0.50;Z=5.64, P<0.001), but couldn’t benefit the overall survival(HR=1.07, 95%CI=0.98-1.16;Z=1.43, P=0.15), and the risk of distant metastasis was not reduced(HR=2.59, 95%CI=1.20-5.61;Z=2.41, P=0.02). Subgroup analyses showed that surgery combined with adjuvant radiotherapy did not reduce the risk of death in HNMM cases(HR=1.10, 95%CI=0.86-1.43;Z=0.77, P=0.44), and that surgery plus postoperative radiotherapy had similar overall survival rate compared with surgery alone(HR=1.12, 95%CI=0.81-1.55;Z=0.70, P=0.48).Conclusions Surgery plus adjuvant radiotherapy can achieve better local control, but not benefit survival. High-quality clinical research is still needed to explore its exact effect. However, due to the complex anatomy of the head and neck, it is still necessary to actively apply adjuvant radiotherapy to control the recurrence of local lesions, and supply it with systemic treatment in order to obtain better survival benefits.