Treatment of Early-Stage Glottic Cancer: Meta-analysis Comparison of Laser Excision versus Radiotherapy
Treatment of Early-Stage Glottic Cancer: Meta-analysis Comparison of Laser Excision versus Radiotherapy
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DOI：
10.2310/7070.2009.080235
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发表时间：
2009-12-01
影响因子：
3.4
通讯作者：
Enepekides, Danny
中科院分区：
文献类型：
--
作者：
Higgins, Kevin M.;Shah, Manish D.;Enepekides, Danny
目的：本研究的主要目的是进行一项荟萃分析，以比较外照射（XRT）和经口激光（TOL）手术切除治疗早期声门癌的肿瘤学结局。次要结果检查是治疗后的声音quality.Design：Meta-analysis.Method：系统的方法被用来识别已发表和未发表的数据。两名评审员筛选了所有标题和摘要的相关性，并独立评估了所有文章。所有确定的研究是retrospective.Main结果措施：局部控制，总生存率，喉切除术的生存率，和治疗后的声音quality.Results：对于肿瘤控制，病例系列汇总为一个复合组使用随机效应模型。这项研究基于7600多名患者。计算合并比值比（OR）和95%置信区间（CI）。TOL手术和XRT之间的局部控制（OR 0.81，95% CI 0.51-1.3）和无喉切除术生存率（OR 0.73，95% CI 0.39-1.35）无显著差异。对于总生存期，分析支持TOL手术（OR 1.48，95% CI 1.19-1.85）。对于语音质量，没有客观的差异，但是，有一个优势XRT.Conclusions的趋势：这是第一项研究，检查管理早期声门癌使用荟萃分析方法。分析显示，尽管总生存率有倾向于TOL手术，但TOL手术和XRT之间的肿瘤结局没有明显差异。然而，有一个趋势，改善治疗后的声音质量与XRT。这是可疑的临床意义，因为客观的声音分析往往不相关的主观评估。
Objectives: The primary objective of this study was to conduct a meta-analysis to compare the oncologic outcomes of external radiation (XRT) and transoral laser (TOL) surgical excision in the treatment of early-stage glottic cancer. The secondary outcome examined was posttreatment voice quality.Design: Meta-analysis.Method: Systematic methods were used to identify published and unpublished data. Two reviewers screened all titles and abstracts for relevance and independently assessed all articles. All identified studies were retrospective.Main Outcome Measures: Local control, overall survival, laryngectomy-free survival, and posttreatment voice quality.Results: For oncologic control, case series were pooled as a composite group using a random effects model. The analysis was based on over 7600 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. There were no significant differences between TOL surgery and XRT for local control (OR 0.81, 95% CI 0.51-1.3) and laryngectomy-free survival (OR 0.73, 95% CI 0.39-1.35). For overall survival, the analysis favoured TOL surgery (OR 1.48, 95% CI 1.19-1.85). For voice quality, there were no objective differences; however, there was a trend toward superiority for XRT.Conclusions: This is the first study to examine the management of early glottic cancer using meta-analytic methodology. The analysis shows that although there is a trend favouring TOL surgery for overall survival, there is no clear difference in oncologic outcome between TOL surgery and XRT. However, there is a trend toward improved posttreatment voice quality with XRT. This is of questionable clinical significance as objective voice analyses often do not correlate with subjective assessments.