Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May;45(Suppl. 1):S56-S70.
doi: 10.14639/0392-100X-suppl.1-45-2025-N1170.

Margins in oncologic nasopharyngeal surgery: a systematic review with meta-analysis

Antonio Daloiso  1   2 , Piergiorgio Gaudioso  1   2 , Alessandro Vinciguerra  3   4 , Stefano Taboni  1   2 , Paolo Castelnuovo  3 , Piero Nicolai  1   2 , Mario Turri-Zanoni  3   4 , Marco Ferrari  1   2 , Paolo Battaglia  3   4
Affiliations
Meta-Analysis

Margins in oncologic nasopharyngeal surgery: a systematic review with meta-analysis

Antonio Daloiso et al. Acta Otorhinolaryngol Ital. 2025 May.

Abstract

Objective: Nasopharyngeal malignancies are rare heterogenous histologies (nasopharyngeal carcinoma [NPC], minor salivary glands carcinomas, and low-grade papillary nasopharyngeal adenocarcinoma) and a significant proportion of patients experience loco-regional recurrence after primary treatment. Resection margin status is a key prognostic factor that influences recurrence and survival, although definitions and criteria for negative, close, and positive margins remain inconsistent. This systematic review with meta-analysis aimed to summarise the existing definitions of resection margins in the literature and evaluate their impact on clinical outcomes in patients undergoing nasopharyngectomy with a specific focus on NPC.

Methods: A systematic literature review was conducted according to PRISMA guidelines. Electronic databases (Scopus, PubMed, and Web of Science) were searched up to November 2024. Studies reporting on surgical margins and survival outcomes in patients with NPC treated with endoscopic or open nasopharyngectomy were included. Pooled odds ratios (OR) for overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were calculated using a random-effects model.

Results: A total of 45 studies met the inclusion criteria, with 12 included in the meta-analysis. Positive surgical margins were associated with worse 5-year DFS (OR 2.21, 95% CI 1.55-3.14, p < 0.001), while no significant impact was observed on 3-year DFS (OR 2.3, p = 0.239), 3-year OS (OR 2, p = 0.167), 5-year OS (OR 2.98, p = 0.115), 3-year DSS (OR 1.25, p = 0.761), or 5-year DSS (OR 2.57, p = 0.265). Margin positivity rates were 16.9% for endoscopically-treated NPC, 20.6% for open-surgery NPC, and 20.6% for mixed histology, with no significant difference between surgical approaches (p = 0.995).

Conclusions: Positive resection margins significantly impact DFS in recurrent NPC. Standardised margin definitions are needed to improve prognostication and guide decisions on adjuvant therapy.

Keywords: endoscopic surgery; nasopharyngeal cancer; nasopharyngectomy; surgical margin; survival outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Cover figure.
Cover figure.
Panel including T2-weighted image of a patient affected by local recurrence of a nasopharyngeal carcinoma in the left lateral recess of the nasopharynx, alongside with schema and photographs of the resected specimen. Location and status of relevant margins are displayed.
Figure 1.
Figure 1.
PRISMA diagram summarising the electronic database search and inclusion/exclusion process of the review.
Figure 2.
Figure 2.
Forest plot for overall survival at 3- (A) and 5-years (B).
Figure 3.
Figure 3.
Forest plot for disease-specific survival at 3- (A) and 5-years (B).
Figure 4.
Figure 4.
Forest plot for disease-free survival at 3- (A) and 5-years (B).
Figure 5.
Figure 5.
Funnel plot of meta-analysis. Black dots identify each study’s characteristics in terms of standard error and standardised mean difference.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Bray F, Ferlay J, Soerjomataram I, et al. . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492 10.3322/caac.21492 - DOI - PubMed
    1. Badoual C. Update from the 5th edition of the World Health Organization Classification of Head and Neck Tumors: oropharynx and nasopharynx. Head Neck Pathol 2022;16:19-30. https://doi.org/10.1007/s12105-022-01449-2 10.1007/s12105-022-01449-2 - DOI - PMC - PubMed
    1. Liu J, Yu H, Sun X, et al. . Salvage endoscopic nasopharyngectomy for local recurrent or residual nasopharyngeal carcinoma: a 10-year experience. Int J Clin Oncol 2017;22:834-842. https://doi.org/10.1007/s10147-017-1143-9 10.1007/s10147-017-1143-9 - DOI - PubMed
    1. Chen Y-P, Chan ATC, Le Q-T, et al. . Nasopharyngeal carcinoma. Lancet 2019;394:64-80. https://doi.org/10.1016/S0140-6736(19)30956-0 10.1016/S0140-6736(19)30956-0 - DOI - PubMed
    1. Chee J, Ting Y, Ong YK, et al. . Relapse status as a prognostic factor in patients receiving salvage surgery for recurrent or residual nasopharyngeal cancer after definitive treatment. Head Neck 2016;38:1393-1400. https://doi.org/10.1002/hed.24451 10.1002/hed.24451 - DOI - PubMed

MeSH terms

LinkOut - more resources