| Objective:Through Meta-analysis,the effects of two treatment strategies including surgery plus adjuvant radiotherapy and surgery alone on the overall survival and local recurrence of head and neck mucosal melanoma mucosa were explored.It's aiming to explore the optimal treatment model of head and neck mucosa melanoma with a view to providing evidence-based medicine for clinical decision making.Methods:Comprehensively searched the Wanfang Database,Chinese journal Full-text Database(CNKI),PubMed / MEDLINE datebase and The Cochrane Library.The last search time was July 2019.The search content was the published study which contains the prognosis of head and neck mucosal melanoma compared with two treatment strategies including surgery plus adjuvant radiotherapy and surgery alone,and the search documents were filtered through the inclusion and exclusion criteria.The included studies were scored according to the Newcastle-Ottawa Scale(NOS),and literature and research data were extracted.The Cochrane systematic review software RevMan5.3 software was used to perform a meta-analysis on the extracted data.Hazard ratio(hazard ratio,HR)was used to evaluate the treatment outcome indicators of the two groups.The included literatures were tested for heterogeneity by software and the corresponding effect models were used for data analysis.The prognostic analysis of the two treatment strategies was evaluated by their differences in overall survival rate,local recurrence rate,distant metastasis rate,and disease-specific survival rate.Results:A total of 11 studies were included,all of which were retrospective cohort studies involving 3211 patients.Except for one literature,which did not count the specific enrollment,1046 patients underwent surgery alone(S)and 1213 patients underwent surgery plus adjuvant radiation therapy(SRT).Meta analysis results show:(1)Overall survival rate: A total of 3,074 patients were included.Because one article did not specifically count the number of participants in the S group and the SRT group,excluding the study,there were 1,046 patients in the S group and 1,213 patients in the SRT group.There was no significant difference in overall survival between the two groups,with HR = 1.07(95% CI = 0.98-1.16)and Z = 1.43(P= 0.15).Subgroup analysis statistics:Sinonasal mucosal melanoma(SNMM)group had268 patients in group S and 276 patients in SRT group;Postoperative radiotherapy group had 170 patients in the S group and 168 patients in the SRT group.Subgroup analysis shows:In the SNMM group,there was no significant difference in overall survival between the two groups,with HR = 1.10(95% CI = 0.86-1.43),Z = 0.77(P = 0.44);In the postoperative radiotherapy group,the difference in overall survival rate was not statistically significant,with HR = 1.12(95% CI = 0.81-1.55),Z = 0.70(P = 0.48).(2)local recurrence rate:A total of 514 patients were included,including 203 patients in the S group and 311 patients in the SRT group.The difference in local recurrence rate was statistically significant,with HR = 0.35(95% CI = 0.24-0.50)and Z = 5.64(P <0.001).(3)distant metastasis rate:A total of 229 patients were included,including 112 patients in the S group and 117 patients in the SRT group.The difference in distant metastasis rate between the two groups was statistically significant,with HR = 2.59(95%CI = 1.20-5.61),Z = 2.41(P = 0.02).(4)Disease-specific survival rate:A total of 1077 patients were included.After removing the 1 literature,there were 93 patients in group S and 169 patients in SRT.There was no statistically significant difference in disease-specific survival rates between the two groups,with HR = 0.76(95% CI =0.52-1.12)and Z = 1.38(P = 0.17).Conclusion:Surgery plus adjuvant radiotherapy can achieve better local control,but it can not benefit survival.This may be because adjuvant radiotherapy cannot reduce the risk of distant metastasis of tumors.High-quality clinical research is still needed to explore its exact effect.However,due to the complex anatomy of the head and neck,it is difficult to completely remove the tumor and obtain a negative resection margin.It is still necessary to actively apply adjuvant radiotherapy to control the recurrence of local lesions,and supplement it with systemic treatment in order to obtain better survival benefits. |
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