口腔癌患者张口受限患病率的meta分析

A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer

目的·通过meta分析研究口腔癌患者张口受限患病率。方法·检索中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献数据库(CBM)、PubMed、Ovid、EMbase、Cochrane Library、Web of Science/SciSearch、ClinicalTrials.gov数据库关于口腔癌患者张口受限患病率的观察性研究(包括前瞻性研究、回顾性研究以及横断面研究),检索时限为建库到2022年4月30日。由2位研究人员按照纳入与排除标准对所获文献独立进行筛选、提取,采用非随机对照试验方法学评价指标(methodological index for non-randomized studies,MINORS)进行文献质量评价。以张口受限患病率为结局指标合并数据,采用Stata 15.0软件进行meta分析,并根据检测时间、肿瘤部位和肿瘤分期进行亚组分析。使用GRADE profiler 3.6软件,依据GRADE(Grading of Recommendations Assessment,Development,and Evaluation)证据质量分级系统对结局指标的证据质量进行评价。结果·初检共获得3719篇文献,最终纳入18篇文献,包括2701例调查对象。Meta分析结果显示,口腔癌患者张口受限总患病率为42.7%(95%CI 27.0%~59.1%)。亚组分析结果显示,手术前、术后3个月、术后6个月和术后1年及以上的口腔癌患者张口受限患病率分别为29.6%(95%CI 9.0%~55.8%)、75.2%(95%CI 68.3%~81.5%)、59.1%(95%CI 38.8%~77.9%)、22.3%(95%CI 2.0%~54.3%)。T1~T2期和T3~T4期口腔癌患者张口受限患病率分别为38.6%(95%CI 26.0%~52.0%)、99.6%(95%CI 93.9%~100.0%)。磨牙后三角区、牙龈、舌部、唾液腺、口底和唇部口腔癌患者张口受限患病率分别为93.1%(95%CI 68.5%~100.0%)、68.1%(95%CI 52.9%~81.7%)、46.1%(95%CI 11.6%~82.7%)、26.1%(95%CI 15.9%~37.5%)、21.9%(95%CI 0.7%~54.0%)、3.1%(95%CI 0~9.3%)。GRADE证据质量分级系统表明结局指标的证据质量为极低。结论·口腔癌患者张口受限总患病率较高,近50%;其中术后3个月、术后6个月、T3~T4期或肿瘤位于磨牙后三角区的患者患病率更高。

Objective·To study the prevalence of mouth opening restriction in oral cancer patients by meta-analysis.Methods·China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Journal Database(VIP),Wanfang Data(Wanfang),Chinese BioMedical Literature Database(CBM),PubMed,Ovid,EMbase,Cochrane Library,Web of Science/SciSearch,and ClinicalTrials.gov were searched for observational studies about the prevalence rate of restricted mouth opening in oral cancer patients(including prospective,retrospective,and cross-sectional studies).The time limit for retrieval was from the database establishment to April 30th,2022.The obtained documents were independently screened and extracted according to the inclusion and exclusion criteria,and the literature quality evaluation was performed by using methodological index for non-randomized studies(MINORS).The data were combined with the mouth-opening-restricted prevalence rate as the outcome indicator,the meta-analysis was performed by using Stata 15.0 software,and the subgroup analysis was performed based on the detection time,tumor site,and tumor stage.The evidence quality of outcome indicators was evaluated by using GRADE profiler 3.6 software according to GRADE(Grading of Recommendations Assessment,Development,and Evaluation)system.Results·A total of 3719 documents were obtained during the initial examination,and 18 documents were finally included,including 2701 objects.The meta-analysis results showed that the total prevalence rate of mouth opening restriction in oral cancer patients was 42.7%(95%CI 27.0%?59.1%).The results of subgroup analysis showed that the prevalence rates of mouth opening restriction in patients with oral cancer before surgery,and 3 months,6 months and 1 year or more after surgery were 29.6%(95%CI 9.0%?55.8%),75.2%(95%CI 68.3%?81.5%),59.1%(95%CI 38.8%?77.9%)and 22.3%(95%CI 2.0%?54.3%),respectively.The prevalence rates of mouth opening restriction in patients with oral cancer at T1?T2 stage and T3?T4 stage were 38.6%(95%CI 26.0%?52.0%)and 99.6%(95%CI 93.9%?100.0%)respectively.The prevalence rates of mouth opening restriction in patients with oral cancer in the retromolar triangle,the gingiva,the tongue,the salivary gland,the floor of mouth and the lip were 93.1%(95%CI 68.5%?100.0%),68.1%(95%CI 52.9%?81.7%),46.1%(95%CI 11.6%?82.7%),26.1%(95%CI 15.9%?37.5%),21.9%(95%CI 0.7%?54.0%),and 3.1%(95%CI 0?9.3%),respectively.The GRADE system for evidence quality grading indicated that the quality of evidence for outcome indicator was extremely low.Conclusion·The total prevalence rate of mouth opening restriction in patients with oral cancer is high,nearly 50%;the patients at 3 months after surgery,at 6 months after surgery,at T3?T4 stage or whose tumor located in the retromolar triangle have higher prevalence rates.