激光治疗与放射治疗在早期声门癌治疗中对比的Meta分析

A meta-analysis for the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma

目的:通过本研究为临床早期声门癌治疗方法的选择提供依据。方法:通过电子检索数据库Med-line(1990-2010)、Embase(1990-2010)、Cochrane图书馆、中国生物医学文献光盘数据库(1990-2010)、中文学术期刊全文数据库(1994-2010)、中文科技期刊全文数据库(1989-2010),中文生物医学期刊数据库(1994-2010)及万方数据库。用RevMan5.0计算OR值。结果:在并发症方面,由于纳入文献存在显著异质性,若使用Meta分析研究,可能会产生错误的结果,故放弃使用Meta分析。在复发和5年局部控制率方面,存在较显著异质性,消除异质性或采用亚组分析后,放射治疗与激光治疗比较差异无统计学意义,但激光治疗较放射治疗有更少的复发和更高的局部控制。而在死亡、总生存、喉保留方面,纳入文献异质性较小,进行合并后,得出在这3个方面,内镜下激光治疗更具优越性,与放射治疗后的结果相比,差异有统计学意义。结论:激光治疗可作为早期声门癌首选治疗方案。但对于肿瘤较大、侵犯前连合的患者,建议首选传统手术治疗。本研究中纳入的数据属回顾性研究,故需增加更多科学、严谨的研究数据或随机对照试验结果才可得出更科学的结论。

Objective： To investigate the effectiveness external radiation （XRT） vs transoral laser surgery （TOL） for treatment of early glottic carcinoma. Method ： Medline（ 1990-2010）, Embase（ 1990-2010）, Cochrane Library,CBM（1990-2010）, CNKI（1994-2010）, Wanfang Database were searched for published case-control studies investigating the effectiveness external radiation vs transoral laser surgery for treatment of early glottic carcinoma. The odds ratio was calculated. Meta-analyses were performed by RevManS. 0.2 Software. Result： In the complications of this study, there was significant heterogeneity in the literatures, so Meta analysis was given up. In the recurrence and 5-years locoregional control,XRT group was no significant difference with TOL group by eliminating the heterogeneity or using the subgroup analysis, but the results till showed there was less recurrence and more locoregional control in TOL group than those in XRT group. In death of disease, overall survival and laryneal preservation, the differences were statistically significant. Conclusions：TOI. could be complete in the clinic and the cost was much more cheaper than XRT. So TOL could be used as the first choice for the treatment of early glottic carcinoma versus XRT. But for larger tumors,involving the anterior commissure, there was no clear conclusion. Based on literatures,traditional surgery was the proposed choice. We recognize that the datas included in our study are retrospective studies, for a more scientific conclusion,we need more RCTs.