口腔癌患者张口受限患病率的meta分析

doi:10.3969/j.issn.1674-8115.2023.01.008

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

口腔癌患者张口受限患病率的meta分析

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

^1.成都中医药大学护理学院，成都 610075
^2.上海交通大学医学院附属第九人民医院护理部，上海 200011
^3.上海交通大学护理学院，上海 200025
^4.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

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:
长三角科技创新共同体项目(21002411300)

A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer

YANG Ling¹^,²(), HOU Lili²^,³(), ZHAO Yan²^,³, CHEN Weihong¹^,², ZHANG Jinfeng⁴, MAO Yan⁴

^1.Chengdu University of Traditional Chinese Medicine School of Nursing, Chengdu 610075, China
^2.Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^3.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
^4.Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China

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:
Yangtze River Delta Science and Technology Innovation Community Project(21002411300)

摘要/Abstract

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。

关键词: 口腔肿瘤, 张口受限, 患病率, meta分析

Abstract:

Objective ·To study the prevalence of mouth opening restriction in oral cancer patients by meta-analysis. Methods ·China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang Data (Wanfang), Chinese BioMedical Literature Database (CBM), PubMed, Ovid, EMbase, Cochrane Library, Web of Science/SciSearch, and ClinicalTrials.gov were searched for observational studies about the prevalence rate of restricted mouth opening in oral cancer patients (including prospective, retrospective, and cross-sectional studies). The time limit for retrieval was from the database establishment to April 30th, 2022. The obtained documents were independently screened and extracted according to the inclusion and exclusion criteria, and the literature quality evaluation was performed by using methodological index for non-randomized studies (MINORS). The data were combined with the mouth-opening-restricted prevalence rate as the outcome indicator, the meta-analysis was performed by using Stata 15.0 software, and the subgroup analysis was performed based on the detection time, tumor site, and tumor stage. The evidence quality of outcome indicators was evaluated by using GRADE profiler 3.6 software according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. Results ·A total of 3 719 documents were obtained during the initial examination, and 18 documents were finally included, including 2 701 objects. The meta-analysis results showed that the total prevalence rate of mouth opening restriction in oral cancer patients was 42.7% (95%CI 27.0%?59.1%). The results of subgroup analysis showed that the prevalence rates of mouth opening restriction in patients with oral cancer before surgery, and 3 months, 6 months and 1 year or more after surgery were 29.6% (95%CI 9.0%?55.8%), 75.2% (95%CI 68.3%?81.5%), 59.1% (95%CI 38.8%?77.9%) and 22.3% (95%CI 2.0%?54.3%), respectively. The prevalence rates of mouth opening restriction in patients with oral cancer at T1?T2 stage and T3?T4 stage were 38.6% (95%CI 26.0%?52.0%) and 99.6% (95%CI 93.9%?100.0%) respectively. The prevalence rates of mouth opening restriction in patients with oral cancer in the retromolar triangle, the gingiva, the tongue, the salivary gland, the floor of mouth and the lip were 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%), and 3.1% (95%CI 0?9.3%), respectively. The GRADE system for evidence quality grading indicated that the quality of evidence for outcome indicator was extremely low. Conclusion ·The total prevalence rate of mouth opening restriction in patients with oral cancer is high, nearly 50%; the patients at 3 months after surgery, at 6 months after surgery, at T3?T4 stage or whose tumor located in the retromolar triangle have higher prevalence rates.

Key words: oral neoplasm, mouth opening restriction, prevalence, meta-analysis

中图分类号:

R739.8

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.

图/表 7

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Study	Research type	Population	n	Outcome index
FU， et al （2014）^［10］	Prospective study	Oral cancer patients	104	①②
GONDIVKAR， et al （2021）^［11］	Prospective study	Oral cancer patients	100	①②③④
MARTINS， et al （2020）^［12］	Prosepctive study	Oral cancer patients	35	①③
PANTVAIDYA， et al （2019）^［13］	Prosepctive study	Oral cancer patients	401	①②
AGARWAL， et al （2016）^［14］	Prosepctive study	Oral cancer patients	30	②③④
MINHAS， et al （2017）^［15］	Cross-sectional study	Patients with oral squamous cell carcinoma	81	①
OWOSHO， et al （2016）^［16］	Retrospectivel study	Oral cancer patients	54	①③
SCOTT， et al （2011）^［17］	Prosepctive study	Oral cancer patients	98	②
WETZELS， et al （2014）^［18］	Prospective study	Oral cancer patients	143	②
HSIEH， et al （2014）^［19］	Prospective study	Patients with oral squamous cell carcinoma	22	①
VAN DER GEER， et al （2019）^［20］	Cross-sectional study	Oral cancer patients	730	③
STEINER， et al （2015）^［21］	Prospective study	Oral cancer patients	45	①
ASTRADSSON， et al （2018）^［22］	Prospective study	Oral cancer patients	27	①②
JOHNSON， et al （2010）^［3］	Prospective study	Oral cancer patients	246	③
PEI-LING， et al （2019）^［23］	Cross-sectional study	Oral cancer patients	69	②
BATISTA， et al （2017）^［24］	Prospective study	Oral cancer patients	100	①
NIKHAR， et al （2017）^［25］	Prospective study	Oral cancer patients	156	①
MISHRA， et al （2005）^［26］	Prospective study	Oral cancer patients	260	①

Study	Research type	Population	n	Outcome index
FU， et al （2014）^［10］	Prospective study	Oral cancer patients	104	①②
GONDIVKAR， et al （2021）^［11］	Prospective study	Oral cancer patients	100	①②③④
MARTINS， et al （2020）^［12］	Prosepctive study	Oral cancer patients	35	①③
PANTVAIDYA， et al （2019）^［13］	Prosepctive study	Oral cancer patients	401	①②
AGARWAL， et al （2016）^［14］	Prosepctive study	Oral cancer patients	30	②③④
MINHAS， et al （2017）^［15］	Cross-sectional study	Patients with oral squamous cell carcinoma	81	①
OWOSHO， et al （2016）^［16］	Retrospectivel study	Oral cancer patients	54	①③
SCOTT， et al （2011）^［17］	Prosepctive study	Oral cancer patients	98	②
WETZELS， et al （2014）^［18］	Prospective study	Oral cancer patients	143	②
HSIEH， et al （2014）^［19］	Prospective study	Patients with oral squamous cell carcinoma	22	①
VAN DER GEER， et al （2019）^［20］	Cross-sectional study	Oral cancer patients	730	③
STEINER， et al （2015）^［21］	Prospective study	Oral cancer patients	45	①
ASTRADSSON， et al （2018）^［22］	Prospective study	Oral cancer patients	27	①②
JOHNSON， et al （2010）^［3］	Prospective study	Oral cancer patients	246	③
PEI-LING， et al （2019）^［23］	Cross-sectional study	Oral cancer patients	69	②
BATISTA， et al （2017）^［24］	Prospective study	Oral cancer patients	100	①
NIKHAR， et al （2017）^［25］	Prospective study	Oral cancer patients	156	①
MISHRA， et al （2005）^［26］	Prospective study	Oral cancer patients	260	①

Study	Score of item/point								Total score of MINORS/point
Study	①	②	③	④	⑤	⑥	⑦	⑧	Total score of MINORS/point
FU， et al （2014）^［10］	2	2	2	2	0	2	2	0	12
GONDIVKAR， et al （2021）^［11］	2	2	2	2	0	0	2	2	12
MARTINS， et al （2020）^［12］	2	2	2	2	0	2	2	0	12
PANTVAIDYA， et al （2019）^［13］	2	2	2	2	0	2	2	0	12
AGARWAL， et al （2016）^［14］	2	2	2	2	0	2	2	0	12
MINHAS， et al （2017）^［15］	2	2	2	2	0	2	2	0	12
OWOSHO， et al （2016）^［16］	2	2	2	2	0	0	2	2	12
SCOTT， et al （2011）^［17］	2	2	2	2	0	2	2	0	12
WETZELS， et al （2014）^［18］	2	2	2	2	0	2	2	0	12
HSIEH， et al （2014）^［19］	2	2	2	2	0	2	2	0	12
VAN DER GEER， et al （2019）^［20］	2	2	2	2	0	2	2	0	12
STEINER， et al （2015）^［21］	2	2	2	2	0	2	2	0	12
ASTRADSSON， et al （2018）^［22］	2	0	2	2	0	0	2	2	10
JOHNSON， et al （2010）^［3］	2	2	2	2	0	2	2	0	12
PEI-LING， et al （2019）^［23］	2	2	2	2	0	2	2	0	12
BATISTA， et al （2017）^［24］	2	2	2	2	0	0	0	0	8
NIKHAR， et al （2017）^［25］	2	2	2	2	0	2	2	0	12
MISHRA， et al （2005）^［26］	2	2	2	2	0	2	2	0	12

Study	Score of item/point								Total score of MINORS/point
Study	①	②	③	④	⑤	⑥	⑦	⑧	Total score of MINORS/point
FU， et al （2014）^［10］	2	2	2	2	0	2	2	0	12
GONDIVKAR， et al （2021）^［11］	2	2	2	2	0	0	2	2	12
MARTINS， et al （2020）^［12］	2	2	2	2	0	2	2	0	12
PANTVAIDYA， et al （2019）^［13］	2	2	2	2	0	2	2	0	12
AGARWAL， et al （2016）^［14］	2	2	2	2	0	2	2	0	12
MINHAS， et al （2017）^［15］	2	2	2	2	0	2	2	0	12
OWOSHO， et al （2016）^［16］	2	2	2	2	0	0	2	2	12
SCOTT， et al （2011）^［17］	2	2	2	2	0	2	2	0	12
WETZELS， et al （2014）^［18］	2	2	2	2	0	2	2	0	12
HSIEH， et al （2014）^［19］	2	2	2	2	0	2	2	0	12
VAN DER GEER， et al （2019）^［20］	2	2	2	2	0	2	2	0	12
STEINER， et al （2015）^［21］	2	2	2	2	0	2	2	0	12
ASTRADSSON， et al （2018）^［22］	2	0	2	2	0	0	2	2	10
JOHNSON， et al （2010）^［3］	2	2	2	2	0	2	2	0	12
PEI-LING， et al （2019）^［23］	2	2	2	2	0	2	2	0	12
BATISTA， et al （2017）^［24］	2	2	2	2	0	0	0	0	8
NIKHAR， et al （2017）^［25］	2	2	2	2	0	2	2	0	12
MISHRA， et al （2005）^［26］	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）

口腔癌患者张口受限患病率的meta分析

A meta-analysis of prevalence of mouth opening restriction in patients with oral cancer

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Metrics

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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