Abstract：
BACKGROUND: Head and neck carcinoma of unknown primary (CUP) represents a challenging diagnostic process when standard work-up fails to identify the primary tumour site. The aim of this systematic review and meta-analysis was to evaluate the diagnostic utility and complication profile of transoral robotic surgery (TORS) tongue base mucosectomy (TBM) in the management of CUP.
METHODS: An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates.
RESULTS: Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification.
CONCLUSIONS: This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.
METHODS: An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates.
RESULTS: Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification.
CONCLUSIONS: This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.
摘要：
背景：当标准检查无法确定原发肿瘤部位时，未知原发头颈部癌（CUP）代表了一个具有挑战性的诊断过程。这项系统评价和荟萃分析的目的是评估经口机器人手术（TORS）舌根粘膜切除术（TBM）在CUP管理中的诊断实用性和并发症特征。
方法：在EMBASE中进行了电子数据库搜索，MEDLINE,PubMed和Cochrane数据库。对比例进行荟萃分析，以估计检出率和并发症发生率的总体比例。
结果：有235例患有TORSTBM的CUP患者的9项研究纳入最终分析。总体合并肿瘤检出率为66.2%[95%置信区间(CI)56.1-75.8]。人乳头瘤病毒（HPV）阳性病例中肿瘤检测的发生率（81.5％，95％CI60.8-96.4）显着高于HPV阴性病例（2.3％，95%CI0.00-45.7）。加权总并发症率为11.4%（95%CI7.2-16.2）。根据Clavien-Dindo分类，大多数是I级或II级（80％）。
结论：这项荟萃分析表明，在CUP患者中，TORS定位原发肿瘤部位是安全有效的。虽然目前的数据支持在HPV阳性患者中使用TORS，需要更多的HPV阴性病例来确定TORS的真正诊断效果,然后才能在该特定亚组中推断任何有效结论.进一步的研究应该集中在高质量的前瞻性试验和严格的方法学工作，以尽量减少异质性，并允许更准确的统计分析。
方法：在EMBASE中进行了电子数据库搜索，MEDLINE,PubMed和Cochrane数据库。对比例进行荟萃分析，以估计检出率和并发症发生率的总体比例。
结果：有235例患有TORSTBM的CUP患者的9项研究纳入最终分析。总体合并肿瘤检出率为66.2%[95%置信区间(CI)56.1-75.8]。人乳头瘤病毒（HPV）阳性病例中肿瘤检测的发生率（81.5％，95％CI60.8-96.4）显着高于HPV阴性病例（2.3％，95%CI0.00-45.7）。加权总并发症率为11.4%（95%CI7.2-16.2）。根据Clavien-Dindo分类，大多数是I级或II级（80％）。
结论：这项荟萃分析表明，在CUP患者中，TORS定位原发肿瘤部位是安全有效的。虽然目前的数据支持在HPV阳性患者中使用TORS，需要更多的HPV阴性病例来确定TORS的真正诊断效果,然后才能在该特定亚组中推断任何有效结论.进一步的研究应该集中在高质量的前瞻性试验和严格的方法学工作，以尽量减少异质性，并允许更准确的统计分析。
