鼻咽癌放疗后分泌性中耳炎影响因素的Meta分析

Factors influencing secretory otitis media after radiotherapy for nasopharyngeal carcinoma:a Meta-analysis

目的对鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)形成的影响因素进行系统评价。方法检索英文数据库(Pubmed、Embase、Cochrane library)、中文数据库(中国知网、万方、维普),检索时间为数据库建库至2021年8月15日。按照纳入标准与排除标准检索文献后获取临床研究资料。使用Review Manager 5.4对纳入的研究进行Meta分析。质量评价采用New Castle-Ottawa Scale(NOS)进行评估。使用二分类变量描述性别、腭帆张肌萎缩程度≥30%、咽鼓管受累、肿瘤分期(T1-T2、T3-T4)、放疗剂量≥70 Gy以及是否使用调强放射治疗(IMRT)。使用连续变量描述年龄和放疗时间。使用随机效应模型评估纳入的数据。结果本文共纳入7项病例对照研究(757例患者)。结果显示年龄、性别和是否使用IMRT对放疗后SOM形成的影响上差异无统计学意义(P>0.05)。而腭帆张肌萎缩程度≥30%、咽鼓管受累、肿瘤分期T1-T2、T3-T4、放疗剂量≥70 Gy、放疗时间对放疗后SOM形成的影响具有统计学意义(P<0.05)。结论腭帆张肌萎缩程度≥30%、咽鼓管受累、肿瘤分期(T1-T2、T3-T4)、放疗剂量≥70 Gy和放疗时间可能是影响NPC放疗后SOM形成的因素。

Objective To evaluate the influencing factors of secretory otitis media(SOM)after radiotherapy for nasopharyngeal carcinoma(NPC)systematically.Methods English databases(Pubmed,Embase,Cochrane library)and Chinese databases(CNKI,Wanfang,Weipu)were searched from the establishment of the database to August 15,2021.According to the inclusion criteria and exclusion criteria,clinical research data were obtained.Meta-analysis of the involved studies was performed using Review Manager 5.4.The New Castle-Ottawa Scale(NOS)was used for quality evaluation.The binary variables were used to describe gender,staphylinus externus atrophy≥30%,eustachian tube involvement,tumor stage(T1-T2,T3-T4),radiotherapy dosage≥70Gy,and whether to use intensity-modulated radiotherapy(IMRT).The continuous variables were used to describe age and radiotherapy duration.The random effect model was used to evaluate the involved data.Results Seven case-control studies(757 patients)were included in this study.The results showed that age(P=0.35),gender(P=0.77)and whether to use IMRT(P=0.76)had no statistically significant differences in the effects of SOM formation after radiotherapy.Staphylinus externus atrophy≥30%(P=0.01),eustachian tube involvement(P<0.01),tumor stage T1-T2(P=0.02)and T3-T4(P=0.02),radiotherapy dosage≥70 Gy(P<0.01)as well as radiotherapy duration(P<0.01)had statistically significant effects on the formation of SOM after radiotherapy.Conclusion The atrophy degree of staphylinus externus≥30%,eustachian tube involvement,tumor stage(T1-T2,T3-T4),radiotherapy dosage≥70 Gy,and radiotherapy duration may be factors influencing the formation of SOM after radiotherapy for NPC.