Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | https://hdl.handle.net/11449/251351 http://lattes.cnpq.br/1232005349211661 |
Resumo: | The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL, and COCHRANE until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. The combined estimate of RR was 0.48 (95%CI 0.36‒0.63), without heterogeneity nor evidence of publication bias (p>0.3). The RD resulted in 2.9% (95%CI 1.0%‒4.9%; NNT=35). Regarding subgroup analysis, the RR for BBC was 0.37 (95%CI 0.25‒0.54), and RD was 3.7% (95%CI 0.8%‒6.5%; NNT=28). For SCC, RR was 0.57 (95%CI 0.29‒1.13), and RD was 1.9% (95%CI 0.8%‒4.7%; NNT=53). Among primary tumors, RR was 0.39 (95%CI 0.28‒0.54), and for recurrent tumors was 0.67 (95%CI 0.30‒1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumors. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount. |
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Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanáliseEfficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: a systematic review and meta-analysisCarcinoma basocelularCarcinoma espinocelularCirurgia micrográficaRecidivaRevisão sistemáticaBasal cell carcinomaSquamous cell carcinomaMicrographic surgeryRelapseSystematic reviewThe standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL, and COCHRANE until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. The combined estimate of RR was 0.48 (95%CI 0.36‒0.63), without heterogeneity nor evidence of publication bias (p>0.3). The RD resulted in 2.9% (95%CI 1.0%‒4.9%; NNT=35). Regarding subgroup analysis, the RR for BBC was 0.37 (95%CI 0.25‒0.54), and RD was 3.7% (95%CI 0.8%‒6.5%; NNT=28). For SCC, RR was 0.57 (95%CI 0.29‒1.13), and RD was 1.9% (95%CI 0.8%‒4.7%; NNT=53). Among primary tumors, RR was 0.39 (95%CI 0.28‒0.54), and for recurrent tumors was 0.67 (95%CI 0.30‒1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumors. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount.O tratamento padrão para o carcinoma basocelular (CBC) e carcinoma espinocelular (CEC) envolve a exérese através da cirurgia convencional (CC) com margem de segurança predefinida ou da cirurgia micrográfica (CM) com controle microscópico de margem. Estudos anteriores relataram superioridade da CM na redução de recidivas de CBC e CEC de alto risco. Esta revisão sistemática teve como objetivo avaliar as taxas de recidiva da CM e CC, incluindo ensaios clínicos randomizados (ECR) e estudos de coorte. Realizou-se revisão sistemática e meta-análise de estudos encontrados no PubMed, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL e COCHRANE até maio de 2023. Foram incluídos ECRs e coortes envolvendo pacientes com CBC ou CEC submetidos à CM e CC. A avaliação do risco de viés seguiu as ferramentas recomendadas pela Cochrane para ECRs e coortes, e a certeza de evidência seguiu a abordagem GRADE. Estimativas agrupadas foram utilizadas para determinar o risco relativo (RR) e a diferença de risco absoluto (RD) usando um modelo de efeitos aleatórios. Foram incluídos dezessete estudos, sendo dois ECRs e quinze coortes. A estimativa combinada do RR foi de 0,48 (IC95% 0,36‒0,63), sem heterogeneidade ou evidência de viés de publicação (p>0,3). O RD resultou em 2,9% (IC95% 1,0%‒4,9%; NNT=35). Em relação à análise de subgrupos, o RR para CBC foi de 0,37 (IC95% 0,25‒0,54) e o RD foi de 3,7% (IC95% 0,8%‒6,5%; NNT=28). Para CEC, o RR foi de 0,57 (IC95% 0,29‒1,13) e o RD foi de 1,9% (IC95% 0,8%‒4,7%; NNT=53). Entre os tumores primários, o RR foi de 0,39 (IC95% 0,28‒0,54) e para tumores recidivados foi de 0,67 (IC95% 0,30‒1,50). Existem moderadas evidências baseadas em dois ECRs e baixas evidências baseadas em 15 estudos de coorte de que a CM é superior à CC na redução de recidivas de CBCs e tumores primários. O desenvolvimento de protocolos que maximizem a relação custo-efetividade de cada método em diferentes cenários clínicos é fundamental.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)88887.712624/2022-00Universidade Estadual Paulista (Unesp)Hélio Amante Miot [UNESP]Luciana Patrícia Fernandes Abbade [UNESP]Priscila Neri Lacerda2023-11-16T20:14:43Z2023-11-16T20:14:43Z2023-11-16info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfLacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: a systematic review and meta-analysis.https://hdl.handle.net/11449/251351http://lattes.cnpq.br/12320053492116610000-0001-8100-5978porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESP2023-11-28T06:19:33Zoai:repositorio.unesp.br:11449/251351Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T18:59:15.086460Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: a systematic review and meta-analysis |
title |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
spellingShingle |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise Priscila Neri Lacerda Carcinoma basocelular Carcinoma espinocelular Cirurgia micrográfica Recidiva Revisão sistemática Basal cell carcinoma Squamous cell carcinoma Micrographic surgery Relapse Systematic review |
title_short |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
title_full |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
title_fullStr |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
title_full_unstemmed |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
title_sort |
Eficácia na redução de recidiva da cirurgia micrográfica versus cirurgia convencional para carcinoma basocelular e carcinoma espinocelular: revisão sistemática e metanálise |
author |
Priscila Neri Lacerda |
author_facet |
Priscila Neri Lacerda |
author_role |
author |
dc.contributor.none.fl_str_mv |
Hélio Amante Miot [UNESP] Luciana Patrícia Fernandes Abbade [UNESP] |
dc.contributor.author.fl_str_mv |
Priscila Neri Lacerda |
dc.subject.por.fl_str_mv |
Carcinoma basocelular Carcinoma espinocelular Cirurgia micrográfica Recidiva Revisão sistemática Basal cell carcinoma Squamous cell carcinoma Micrographic surgery Relapse Systematic review |
topic |
Carcinoma basocelular Carcinoma espinocelular Cirurgia micrográfica Recidiva Revisão sistemática Basal cell carcinoma Squamous cell carcinoma Micrographic surgery Relapse Systematic review |
description |
The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL, and COCHRANE until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. The combined estimate of RR was 0.48 (95%CI 0.36‒0.63), without heterogeneity nor evidence of publication bias (p>0.3). The RD resulted in 2.9% (95%CI 1.0%‒4.9%; NNT=35). Regarding subgroup analysis, the RR for BBC was 0.37 (95%CI 0.25‒0.54), and RD was 3.7% (95%CI 0.8%‒6.5%; NNT=28). For SCC, RR was 0.57 (95%CI 0.29‒1.13), and RD was 1.9% (95%CI 0.8%‒4.7%; NNT=53). Among primary tumors, RR was 0.39 (95%CI 0.28‒0.54), and for recurrent tumors was 0.67 (95%CI 0.30‒1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumors. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-11-16T20:14:43Z 2023-11-16T20:14:43Z 2023-11-16 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
Lacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: a systematic review and meta-analysis. https://hdl.handle.net/11449/251351 http://lattes.cnpq.br/1232005349211661 0000-0001-8100-5978 |
identifier_str_mv |
Lacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: a systematic review and meta-analysis. 0000-0001-8100-5978 |
url |
https://hdl.handle.net/11449/251351 http://lattes.cnpq.br/1232005349211661 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
publisher.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1808129008854892544 |