METHODS: Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes.
RESULTS: A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings.
CONCLUSIONS: Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.
方法:相关文章检索自Medline,Scopus,和Cochrane根据PRISMA指南。对其临床特征进行了系统评价和荟萃分析,管理,和结果。
结果:共纳入33篇文章,包含957例因CFL而接受OE的患者(加权平均年龄:64.3岁[95%CI:59.9-68.7];58.3%为男性)。最常见的病变是鳞状细胞癌(31.8%),最常见的症状是视力障碍/视力下降(22.5%)。在患者中,302(31.6%)总OE,248(26.0%)延长了OE,87例(9.0%)患有小计OE。游离皮瓣(33.3%),骨内植入物(22.8%),最常用的重建方法是分裂厚度的皮肤移植物(17.2%)。鼻甲眶或鼻甲瘘(22.6%),皮瓣或移植物失败(16.9%),和骨肥大(13%)是最多的报告并发症。关于肿瘤复发,当地的38.6%,32.3%的人很遥远,区域占6.7%。神经周浸润率为17.4%,而淋巴管浸润率为5.0%。在23.6个月的加权平均随访期内(95%CI:13.8-33.4),加权总死亡率为39%(95%CI:28-50%).5年OS率为50%(中位数:61个月[95%CI:46-83])。OS多变量分析未显示任何显著发现。
结论:尽管OE是一种具有破坏性结果的毁容程序,对于精心挑选的晚期CFL患者,这是一个可行的选择.基于肿瘤病理的患者量身定制的方法,扩展,和整体患者的情况是必要的。