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. 2021 Oct 8:11:720418.
doi: 10.3389/fonc.2021.720418. eCollection 2021.

Outcomes of Recurrent Nasopharyngeal Carcinoma Patients Treated With Salvage Surgery: A Meta-Analysis

Yekai Feng  1 , Zhimei Dai  1 , Ruicheng Yan  1 , Feng Li  2 , Xiaosheng Zhong  1 , Haoxin Ye  1 , Caiqing Chen  1 , Shaochong Fan  1 , Cheng Qing  3 , Yong Pan  1 , Haiying Sun  3
Affiliations

Outcomes of Recurrent Nasopharyngeal Carcinoma Patients Treated With Salvage Surgery: A Meta-Analysis

Yekai Feng et al. Front Oncol. .

Abstract

Objective: To assess the efficacy of treatment outcomes of salvage surgery for recurrent nasopharyngeal carcinoma (rNPC).

Methods: We conducted a detailed search of the literatures in biomedical databases published from January 1990 to December 2020. The main research features and results of interest were retrieved from the articles that met the selection criteria for meta-analysis.

Results: A total of 21 articles with 778 patients were included, 17 of which met the meta-analysis inclusion criteria. The pooled 2-year overall survival (OS), 5-year OS, and 2-year disease-free survival (DFS) were 71%, 50% and 61%, respectively. Subgroup analysis was conducted with postoperative adjuvant therapy. The pooled 2-year OS, 5-year OS and 2-year DFS of the postoperative adjuvant therapy group compared with the surgery alone group were 69% vs 72%, 44% vs 56%, and 77% vs 54%, respectively. Univariate and multivariate analyses were performed on 178 patients with detailed individual postoperative survival data in 10 articles. On multivariate analysis, recurrent T (RT) stage and adjuvant therapy were independent predictors of outcomes.

Conclusions: This meta-analysis indicated that recurrent NPC patients can obtain survival benefits from salvage surgery. Accurately assessing the RT stage of the tumor and choosing the appropriate surgical method are important to the success of the surgery. Although the prognostic factors influencing outcome have been studied, conclusive data on the survival benefits are still lacking. Random controlled trials (RCTs) to compare surgery alone and postoperative adjuvant therapy are needed in patients with positive margin status after salvage surgery.

Keywords: adjuvant therapy; meta-analysis; outcome; recurrent nasopharyngeal carcinoma; surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plot of meta-analysis Pooled 2-year OS (A); Pooled 5-year OS (B); Pooled 2-year DFS (C).
Figure 3
Figure 3
Forest plot of subgroup meta-analysis Pooled 2-year OS (A); Pooled 5-year OS (B); Pooled 2-year DFS (C). Subgroups were stratified according to the postoperative adjuvant therapy status of the patients in each study.
Figure 4
Figure 4
Kaplan-Meier survival analysis according to margin status (negative or close vs positive): (A) 2-year OS was 81.0% vs 76.2%. (B) 2-year DFS was 73.3% vs 52.0%. Kaplan-Meier survival analysis according to recurrent T stage (rT1, rT2, rT3, and rT4): (C) 2-year OS was 93.7%, 73.1%, 67.6%, and 30.0%, respectively. (D) 2-year DFS was 93.3%, 43.1%, 52.5%, and 25.0%, respectively. Kaplan-Meier survival analysis according to adjuvant therapy (No, RT, and CHT): (E) 2-year OS was 82.6%, 64.1%, and 80.8%, respectively. (F) 1-year DFS was 88.7%, 65.3%, and 16.7%, respectively.
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