上海交通大学学报(医学版) ›› 2023, Vol. 43 ›› Issue (1): 61-69.doi: 10.3969/j.issn.1674-8115.2023.01.008
杨玲1,2(), 侯黎莉2,3(
), 赵燕2,3, 陈卫宏1,2, 张金凤4, 毛艳4
收稿日期:
2022-04-27
接受日期:
2022-11-07
出版日期:
2023-01-16
发布日期:
2023-01-16
通讯作者:
侯黎莉
E-mail:dalinglingerj66y77@163.com;pisces_liz@163.com
作者简介:
杨 玲(1996—),女,护士,硕士生;电子信箱:dalinglingerj66y77@163.com。
基金资助:
YANG Ling1,2(), HOU Lili2,3(
), ZHAO Yan2,3, CHEN Weihong1,2, ZHANG Jinfeng4, MAO Yan4
Received:
2022-04-27
Accepted:
2022-11-07
Online:
2023-01-16
Published:
2023-01-16
Contact:
HOU Lili
E-mail:dalinglingerj66y77@163.com;pisces_liz@163.com
Supported by:
摘要:
目的·通过meta分析研究口腔癌患者张口受限患病率。方法·检索中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献数据库(CBM)、PubMed、Ovid、EMbase、Cochrane Library、Web of Science/SciSearch、ClinicalTrials.gov数据库关于口腔癌患者张口受限患病率的观察性研究(包括前瞻性研究、回顾性研究以及横断面研究),检索时限为建库到2022年4月30日。由2位研究人员按照纳入与排除标准对所获文献独立进行筛选、提取,采用非随机对照试验方法学评价指标(methodological index for non-randomized studies,MINORS)进行文献质量评价。以张口受限患病率为结局指标合并数据,采用Stata 15.0软件进行meta分析,并根据检测时间、肿瘤部位和肿瘤分期进行亚组分析。使用GRADE profiler 3.6软件,依据GRADE(Grading of Recommendations Assessment, Development,and Evaluation)证据质量分级系统对结局指标的证据质量进行评价。结果·初检共获得3 719篇文献,最终纳入18篇文献,包括2 701例调查对象。Meta分析结果显示,口腔癌患者张口受限总患病率为42.7%(95%CI 27.0%~59.1%)。亚组分析结果显示,手术前、术后3个月、术后6个月和术后1年及以上的口腔癌患者张口受限患病率分别为29.6%(95%CI 9.0%~55.8%)、75.2%(95%CI 68.3%~81.5%)、59.1%(95%CI 38.8%~77.9%)、22.3%(95%CI 2.0%~54.3%)。T1~T2期和T3~T4期口腔癌患者张口受限患病率分别为38.6%(95%CI 26.0%~52.0%)、99.6%(95%CI 93.9%~100.0%)。磨牙后三角区、牙龈、舌部、唾液腺、口底和唇部口腔癌患者张口受限患病率分别为93.1%(95%CI 68.5%~100.0%)、68.1%(95%CI 52.9%~81.7%)、46.1%(95%CI 11.6%~82.7%)、26.1%(95%CI 15.9%~37.5%)、21.9%(95%CI 0.7%~54.0%)、3.1%(95%CI 0~9.3%)。GRADE证据质量分级系统表明结局指标的证据质量为极低。结论·口腔癌患者张口受限总患病率较高,近50%;其中术后3个月、术后6个月、T3~T4期或肿瘤位于磨牙后三角区的患者患病率更高。
中图分类号:
杨玲, 侯黎莉, 赵燕, 陈卫宏, 张金凤, 毛艳. 口腔癌患者张口受限患病率的meta分析[J]. 上海交通大学学报(医学版), 2023, 43(1): 61-69.
YANG Ling, HOU Lili, ZHAO Yan, CHEN Weihong, ZHANG Jinfeng, MAO Yan. A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 61-69.
Study | Research type | Population | n | Outcome index |
---|---|---|---|---|
FU, et al (2014)[ | Prospective study | Oral cancer patients | 104 | ①② |
GONDIVKAR, et al (2021)[ | Prospective study | Oral cancer patients | 100 | ①②③④ |
MARTINS, et al (2020)[ | Prosepctive study | Oral cancer patients | 35 | ①③ |
PANTVAIDYA, et al (2019)[ | Prosepctive study | Oral cancer patients | 401 | ①② |
AGARWAL, et al (2016)[ | Prosepctive study | Oral cancer patients | 30 | ②③④ |
MINHAS, et al (2017)[ | Cross-sectional study | Patients with oral squamous cell carcinoma | 81 | ① |
OWOSHO, et al (2016)[ | Retrospectivel study | Oral cancer patients | 54 | ①③ |
SCOTT, et al (2011)[ | Prosepctive study | Oral cancer patients | 98 | ② |
WETZELS, et al (2014)[ | Prospective study | Oral cancer patients | 143 | ② |
HSIEH, et al (2014)[ | Prospective study | Patients with oral squamous cell carcinoma | 22 | ① |
VAN DER GEER, et al (2019)[ | Cross-sectional study | Oral cancer patients | 730 | ③ |
STEINER, et al (2015)[ | Prospective study | Oral cancer patients | 45 | ① |
ASTRADSSON, et al (2018)[ | Prospective study | Oral cancer patients | 27 | ①② |
JOHNSON, et al (2010)[ | Prospective study | Oral cancer patients | 246 | ③ |
PEI-LING, et al (2019)[ | Cross-sectional study | Oral cancer patients | 69 | ② |
BATISTA, et al (2017)[ | Prospective study | Oral cancer patients | 100 | ① |
NIKHAR, et al (2017)[ | Prospective study | Oral cancer patients | 156 | ① |
MISHRA, et al (2005)[ | Prospective study | Oral cancer patients | 260 | ① |
表1 纳入研究的基本特征
Tab 1 Basic characteristics of the included studies
Study | Research type | Population | n | Outcome index |
---|---|---|---|---|
FU, et al (2014)[ | Prospective study | Oral cancer patients | 104 | ①② |
GONDIVKAR, et al (2021)[ | Prospective study | Oral cancer patients | 100 | ①②③④ |
MARTINS, et al (2020)[ | Prosepctive study | Oral cancer patients | 35 | ①③ |
PANTVAIDYA, et al (2019)[ | Prosepctive study | Oral cancer patients | 401 | ①② |
AGARWAL, et al (2016)[ | Prosepctive study | Oral cancer patients | 30 | ②③④ |
MINHAS, et al (2017)[ | Cross-sectional study | Patients with oral squamous cell carcinoma | 81 | ① |
OWOSHO, et al (2016)[ | Retrospectivel study | Oral cancer patients | 54 | ①③ |
SCOTT, et al (2011)[ | Prosepctive study | Oral cancer patients | 98 | ② |
WETZELS, et al (2014)[ | Prospective study | Oral cancer patients | 143 | ② |
HSIEH, et al (2014)[ | Prospective study | Patients with oral squamous cell carcinoma | 22 | ① |
VAN DER GEER, et al (2019)[ | Cross-sectional study | Oral cancer patients | 730 | ③ |
STEINER, et al (2015)[ | Prospective study | Oral cancer patients | 45 | ① |
ASTRADSSON, et al (2018)[ | Prospective study | Oral cancer patients | 27 | ①② |
JOHNSON, et al (2010)[ | Prospective study | Oral cancer patients | 246 | ③ |
PEI-LING, et al (2019)[ | Cross-sectional study | Oral cancer patients | 69 | ② |
BATISTA, et al (2017)[ | Prospective study | Oral cancer patients | 100 | ① |
NIKHAR, et al (2017)[ | Prospective study | Oral cancer patients | 156 | ① |
MISHRA, et al (2005)[ | Prospective study | Oral cancer patients | 260 | ① |
Study | Score of item/point | Total score of MINORS/point | |||||||
---|---|---|---|---|---|---|---|---|---|
① | ② | ③ | ④ | ⑤ | ⑥ | ⑦ | ⑧ | ||
FU, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
GONDIVKAR, et al (2021)[ | 2 | 2 | 2 | 2 | 0 | 0 | 2 | 2 | 12 |
MARTINS, et al (2020)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
PANTVAIDYA, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
AGARWAL, et al (2016)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
MINHAS, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
OWOSHO, et al (2016)[ | 2 | 2 | 2 | 2 | 0 | 0 | 2 | 2 | 12 |
SCOTT, et al (2011)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
WETZELS, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
HSIEH, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
VAN DER GEER, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
STEINER, et al (2015)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
ASTRADSSON, et al (2018)[ | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 10 |
JOHNSON, et al (2010)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
PEI-LING, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
BATISTA, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 0 | 0 | 0 | 8 |
NIKHAR, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
MISHRA, et al (2005)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
表2 纳入研究的质量评价结果
Tab 2 Quality evaluation results of the included studies
Study | Score of item/point | Total score of MINORS/point | |||||||
---|---|---|---|---|---|---|---|---|---|
① | ② | ③ | ④ | ⑤ | ⑥ | ⑦ | ⑧ | ||
FU, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
GONDIVKAR, et al (2021)[ | 2 | 2 | 2 | 2 | 0 | 0 | 2 | 2 | 12 |
MARTINS, et al (2020)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
PANTVAIDYA, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
AGARWAL, et al (2016)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
MINHAS, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
OWOSHO, et al (2016)[ | 2 | 2 | 2 | 2 | 0 | 0 | 2 | 2 | 12 |
SCOTT, et al (2011)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
WETZELS, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
HSIEH, et al (2014)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
VAN DER GEER, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
STEINER, et al (2015)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
ASTRADSSON, et al (2018)[ | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 10 |
JOHNSON, et al (2010)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
PEI-LING, et al (2019)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
BATISTA, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 0 | 0 | 0 | 8 |
NIKHAR, et al (2017)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
MISHRA, et al (2005)[ | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 12 |
Subgroup | Study/n | I2/% | P value | Effects model | Mouth opening restriction rate (95%CI)/% |
---|---|---|---|---|---|
Time | |||||
Before surgery | 5 | 96.2 | 0.000 | Random | 29.6 (9.0‒55.8) |
3 months after surgery | 2 | 0 | 0.000 | Fixed | 75.2 (68.3‒81.5) |
6 months after surgery | 5 | 94.7 | 0.000 | Random | 59.1 (38.8‒77.9) |
1 year or above after surgery | 3 | 95.7 | 0.000 | Random | 22.3 (2.0‒54.3) |
Tumor stage | |||||
T1‒T2 phase | 2 | 0 | 0.000 | Fixed | 38.6 (26.0‒52.0) |
T3‒T4 phase | 2 | 0 | 0.000 | Fixed | 99.6 (93.9‒100.0) |
Tumor site | |||||
Retromolar triangle | 2 | 0 | 0.000 | Fixed | 93.1 (68.5‒100.0) |
Gingiva | 2 | 0 | 0.000 | Fixed | 68.1 (52.9‒81.7) |
Tongue | 5 | 92.8 | 0.000 | Random | 46.1 (11.6‒82.7) |
Salivary glands | 2 | 0 | 0.000 | Fixed | 26.1 (15.9‒37.5) |
Mouth floor | 4 | 53.2 | 0.093 | Random | 21.9 (0.7‒54.0) |
Lip | 4 | 0 | 0.465 | Fixed | 3.1 (0‒9.3) |
表3 口腔癌患者张口受限患病率的亚组分析结果
Tab 3 Results of subgroup analyses of the prevalence rates of mouth opening restriction in oral cancer patients
Subgroup | Study/n | I2/% | P value | Effects model | Mouth opening restriction rate (95%CI)/% |
---|---|---|---|---|---|
Time | |||||
Before surgery | 5 | 96.2 | 0.000 | Random | 29.6 (9.0‒55.8) |
3 months after surgery | 2 | 0 | 0.000 | Fixed | 75.2 (68.3‒81.5) |
6 months after surgery | 5 | 94.7 | 0.000 | Random | 59.1 (38.8‒77.9) |
1 year or above after surgery | 3 | 95.7 | 0.000 | Random | 22.3 (2.0‒54.3) |
Tumor stage | |||||
T1‒T2 phase | 2 | 0 | 0.000 | Fixed | 38.6 (26.0‒52.0) |
T3‒T4 phase | 2 | 0 | 0.000 | Fixed | 99.6 (93.9‒100.0) |
Tumor site | |||||
Retromolar triangle | 2 | 0 | 0.000 | Fixed | 93.1 (68.5‒100.0) |
Gingiva | 2 | 0 | 0.000 | Fixed | 68.1 (52.9‒81.7) |
Tongue | 5 | 92.8 | 0.000 | Random | 46.1 (11.6‒82.7) |
Salivary glands | 2 | 0 | 0.000 | Fixed | 26.1 (15.9‒37.5) |
Mouth floor | 4 | 53.2 | 0.093 | Random | 21.9 (0.7‒54.0) |
Lip | 4 | 0 | 0.465 | Fixed | 3.1 (0‒9.3) |
Outcome | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Quality |
---|---|---|---|---|---|---|
Total rate | Serious | Serious | No | No | No | Very low |
Time | ||||||
Before surgery | Serious | Serious | No | Serious | ‒ | Very low |
3 months after surgery | Serious | No | No | Serious | ‒ | Very low |
6 months after surgery | Serious | Serious | No | Serious | ‒ | Very low |
1 year or above after surgery | Serious | Serious | No | Serious | ‒ | Very low |
Tumor stage | ||||||
T1‒T2 phase | Serious | No | No | Serious | ‒ | Very low |
T3‒T4 phase | Serious | No | No | Serious | ‒ | Very low |
Tumor site | ||||||
Retromolar triangle | Serious | No | No | Serious | ‒ | Very low |
Gingiva | Serious | No | No | Serious | ‒ | Very low |
Tongue | Serious | Serious | No | Serious | ‒ | Very low |
Salivary glands | Serious | No | No | Serious | ‒ | Very low |
Mouth floor | Serious | Serious | No | Serious | ‒ | Very low |
Lip | Serious | No | No | Serious | ‒ | Very low |
表4 GRADE证据质量等级评价表
Tab 4 Quality of evidence graded by the GRADE system
Outcome | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Quality |
---|---|---|---|---|---|---|
Total rate | Serious | Serious | No | No | No | Very low |
Time | ||||||
Before surgery | Serious | Serious | No | Serious | ‒ | Very low |
3 months after surgery | Serious | No | No | Serious | ‒ | Very low |
6 months after surgery | Serious | Serious | No | Serious | ‒ | Very low |
1 year or above after surgery | Serious | Serious | No | Serious | ‒ | Very low |
Tumor stage | ||||||
T1‒T2 phase | Serious | No | No | Serious | ‒ | Very low |
T3‒T4 phase | Serious | No | No | Serious | ‒ | Very low |
Tumor site | ||||||
Retromolar triangle | Serious | No | No | Serious | ‒ | Very low |
Gingiva | Serious | No | No | Serious | ‒ | Very low |
Tongue | Serious | Serious | No | Serious | ‒ | Very low |
Salivary glands | Serious | No | No | Serious | ‒ | Very low |
Mouth floor | Serious | Serious | No | Serious | ‒ | Very low |
Lip | Serious | No | No | Serious | ‒ | Very low |
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