头颈部鳞状细胞癌远处转移相关因素的Meta分析

A Meta-analysis of Risk Factors for Distant Metastasis of Head and Neck Squamous Cell Carcinoma

目的评价头颈部鳞状细胞癌(HNSCC)远处转移的主要危险因素,为预防决策提供依据。方法计算机检索Cochrane Library、PubMed、EMBASE、CNKI、万方数据库、中国生物医学文献数据库和维普数据库,收集国内外公开发表的有关HNSCC远处转移相关危险因素的研究。外文数据库检索时间为1975—2021年,中文数据库检索时间为2001年1月至2021年6月。由两名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3软件进行Meta分析。结果共纳入17个研究,包含13129例HNSCC患者,其中远处转移者1279例、非远处转移者11850例。Meta分析结果显示:年龄不是HNSCC远处转移的危险因素(OR=1.11,95%CI 0.94-1.33,P=0.23),分化、分期、临床T分期、临床N分期、包膜外扩散、局部控制是HNSCC远处转移的危险因素(OR=0.29,95%CI 0.21-0.40,P<0.00001;OR=0.12,95%CI 0.08-0.18,P<0.00001;OR=0.35,95%CI 0.28-0.43,P<0.00001;OR=0.26,95%CI 0.22-0.31,P<0.0001;OR=3.29,95%CI 2.53-4.27,P<0.00001;OR=0.25,95%CI 0.15-0.43,P<0.00001)。结论HNSCC远处转移与分化、分期、临床T分期、临床N分期、包膜外扩散、局部控制相关,明确HNSCC远处转移的相关因素,可为疾病的有效防治提供循证医学基础。

Objective To evaluate the major risk factors for distant metastasis of head and neck squamous cell carcinoma(HNSCC),to provide references for the prevention decision.Methods Cochrane Library,PubMed,EMBASE,CNKI,Wanfang Database,Chinese Biomedical Literature Database and VIP database were searched by computer to collect domestic and foreign published literatures on risk factors of distant metastasis of HNSCC.The retrieval time of foreign language database was 1975—2021,and that of Chinese database was Jan.2001 to Jun.2021.Two researchers independently screened the literatures,extracted the data,and evaluated the risk of bias of the included studies.Meta-analysis was performed using RevMan 5.3 software.Results A total of 17 studies were included,including 13129 HNSCC patients,including 1279 distant metastases and 11850 non-distant metastases.The results of meta-analysis showed that age was not a risk factor for distant metastasis of HNSCC(OR=1.11,95%CI 0.94-1.33,P=0.23),but differentiation,stage,clinical T stage,clinical N stage,extracapsular diffusion and local control were risk factors for distant metastasis of HNSCC(OR=0.29,95%CI 0.21-0.40,P<0.00001;OR=0.12,95%CI 0.08-0.18,P<0.00001;OR=0.35,95%CI 0.28-0.43,P<0.00001;OR=0.26,95%CI 0.22-0.31,P<0.0001;OR=3.29,95%CI 2.53-4.27,P<0.00001;OR=0.25,95%CI 0.15-0.43,P<0.00001).Conclusion The risk factors related to distant metastasis of HNSCC are the differentiation,stage,clinical T stage,clinical N stage,extrapapsular diffusion,and local control.Identifying the factors related to distant metastasis of HNSCC can provide fundamentals of evidence-based medicine for the effective prevention and treatment of the disease.