Avaliação da taxa de recidiva de carcinoma basocelular entre diferentes técnicas de cirurgia micrográfica: revisão sistemática com metanálise
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2021-10-20
Autores
Lacerda, Priscila Neri
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Universidade Estadual Paulista (Unesp)
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Introdução: Em carcinomas basocelulares (CBC) de alto risco, a cirurgia micrográfica (CM) é terapêutica com elevada preservação de tecido e baixas taxas de recidiva. A técnica de Mohs é a mais utilizada, com limitada utilização das demais técnicas de CM. Não há estudos desenhados para comparação entre os métodos de CM. O objetivo desta revisão foi avaliar a taxa de recidiva de CBC entre as diferentes técnicas de CM. Métodos: Revisão sistemática e metanálise, com busca de artigos na PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL e COCHRANE até março de 2021. Incluídos ensaios clínicos randomizados (ECR) e estudos observacionais envolvendo pacientes com CBC e indicação de diferentes técnicas de CM. A seleção dos estudos e extração de dados foram realizadas de forma independente por três revisores em pares, assim como a avaliação do risco de viés pela ferramenta da Joanna Briggs Institute. Estimativas combinadas foram avaliadas por modelo de efeitos aleatórios (Logit) e a heterogeneidade avaliada pelo teste qui-quadrado (2). Foi utilizado o Software Stata versão 17.0. Resultados: Foram incluídos 18 estudos, sendo 2 ECR’s e 16 estudos observacionais. A taxa de recidiva geral foi de 2% (IC 95% 1,0 – 3,0%; 2= 46,2; p = 0,00; 18 estudos, 10.424 CBC’s). Nos estudos com a técnica de Mohs, a taxa de recidiva foi de de 3,0% (IC 95% 1,0 – 5,0%; 2 = 11,0; p=0,00; 6 estudos; 1.582 CBC’s), com técnica de Munique de 3,0% (IC 95% 2,0 – 5,0%; 2= 0,0; sem heterogeneidade; 3 estudos; 404 CBC’s), com a técnica de Tubingen de 1% (IC 95% 1,0 – 2,0%; 2 = 12,1; p=0,00; 8 estudos; 8.374 CBC’s) e com a técnica de Muffin de 0,0% (IC 95% 0,0 – 6,0%; 1 estudo; 64 CBC’s). Conclusão: As taxas de recidiva entre as técnicas de CM foram baixas e parecem ser semelhantes. Entretanto, o desenho dessa revisão e ausência de estudos primários que comparem diretamente as técnicas não permitem afirmar superioridade entre as mesmas.
Introduction: In high-risk basal cell carcinomas (BCC), micrographic surgery (MS) is a therapeutic with high tissue preservation and low recurrence rates. Mohs technique is the most used, with limited use of other MS techniques. There are no studies designed to compare MS methods. The aim of this review was to assess the BCC recurrence rate between different MS techniques. Methods: Systematic review and meta-analysis, with search for articles in PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL and COCHRANE until March 2021. Randomized clinical trials (RCT) and observational studies involving patients with BCC and indication of different MS techniques were included. Study selection and data extraction were performed independently by three peer reviewers, as was the risk of bias assessment by the Joanna Briggs Institute tool. Pooled estimates were assessed by random effects model (Logit) and heterogeneity assessed by the chi-square test (2). Stata Software version 17.0 was used for analysis. Results: 18 studies were included, 2 RCT’s and 16 observational studies. The overall recurrence rate was 2% (95% CI 1.0 – 3.0%; 2= 46.2; p = 0.00; 18 studies, 10,424 BCC’s). In studies with Mohs technique, the recurrence rate was 3.0% (95% CI 1.0 – 5.0%; 2 = 11.0; p=0.00; 6 studies; 1,582 BCC’s), with Munich technique 3.0% (95% CI 2.0 – 5.0%; 2= 0.0; no heterogeneity; 3 studies; 404 BCC's), with Tubingen technique 1% (CI 95% 1.0 – 2.0%; 2 = 12.1; p=0.00; 8 studies; 8,374 BCC's) and with Muffin technique 0.0% (95% CI 0.0 – 6 0.0%; 1 study; 64 BCC’s). Conclusion: Relapse rates between MS techniques were low and appear to be similar. However, the design of this review and the absence of primary studies that directly compare the techniques do not allow us to assert superiority between them.
Introduction: In high-risk basal cell carcinomas (BCC), micrographic surgery (MS) is a therapeutic with high tissue preservation and low recurrence rates. Mohs technique is the most used, with limited use of other MS techniques. There are no studies designed to compare MS methods. The aim of this review was to assess the BCC recurrence rate between different MS techniques. Methods: Systematic review and meta-analysis, with search for articles in PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE, CINHAL and COCHRANE until March 2021. Randomized clinical trials (RCT) and observational studies involving patients with BCC and indication of different MS techniques were included. Study selection and data extraction were performed independently by three peer reviewers, as was the risk of bias assessment by the Joanna Briggs Institute tool. Pooled estimates were assessed by random effects model (Logit) and heterogeneity assessed by the chi-square test (2). Stata Software version 17.0 was used for analysis. Results: 18 studies were included, 2 RCT’s and 16 observational studies. The overall recurrence rate was 2% (95% CI 1.0 – 3.0%; 2= 46.2; p = 0.00; 18 studies, 10,424 BCC’s). In studies with Mohs technique, the recurrence rate was 3.0% (95% CI 1.0 – 5.0%; 2 = 11.0; p=0.00; 6 studies; 1,582 BCC’s), with Munich technique 3.0% (95% CI 2.0 – 5.0%; 2= 0.0; no heterogeneity; 3 studies; 404 BCC's), with Tubingen technique 1% (CI 95% 1.0 – 2.0%; 2 = 12.1; p=0.00; 8 studies; 8,374 BCC's) and with Muffin technique 0.0% (95% CI 0.0 – 6 0.0%; 1 study; 64 BCC’s). Conclusion: Relapse rates between MS techniques were low and appear to be similar. However, the design of this review and the absence of primary studies that directly compare the techniques do not allow us to assert superiority between them.
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Palavras-chave
Carcinoma basocelular, Recidiva, Cirurgia micrográfica, Basal cell carcinoma, Recidive, Micrographic surgery