手术与非手术治疗下咽癌疗效比较meta分析

Comparative study of surgical and non-surgical treatment in patients with hypopharyngeal cancer:a meta-analysis

目的比较手术与非手术治疗下咽癌的疗效。方法检索Pubmed、Embase、Cochrane、中国知网、维普、万方数据库中符合纳入标准的文献,并根据排除标准进行筛选。对纳入的文献进行质量评价及数据提取,对生存指标的危险比(HR)及保喉率的相对危险度(RR)进行meta分析。结果最终纳入文献11篇,其中2篇为随机对照研究,9篇为队列研究。手术组患者总生存率高于非手术组(HR=0.78,95%CI:0.63~0.96),局部晚期下咽癌患者总生存率(HR=0.73,95%CI:0.51~1.03)及总人群的无进展生存率(HR=0.83,95%CI:0.42~1.65)]在手术组和非手术组间未见差异。非手术组保喉率高于手术组(RR=0.52,95%CI:0.31~0.87)。结论与非手术治疗相比,手术治疗能提高下咽癌患者生存率,但相关研究存在明显的异质性,需多中心大样本量前瞻性研究的证实。

Objective To review and summarize the efficacy of surgery versus non-surgical treatment in patients with hypopharyngeal cancer.Methods Eligible studies were retrieved in databases,including PubMed,Embase,Cochrane,CNKI,CQVIP and Wanfang Data.The pooled hazard ratios(HR)of survival outcomes and relative risk(RR)of larynx preservation were calculated to compare the value of the two treatments in hypopharyngeal cancer.Results Eleven studies were included,including 2 randomized controlled trials and 9 cohort studies.Surgical treatment could improve overall survival(HR=0.78,95%CI:0.63-0.96),however,there was no significant difference of overall survival in patients with locally advanced hypopharyngeal carcinoma(HR=0.73,95%CI:0.51-1.03)and progression free survival of all patients(HR=0.83,95%CI:0.42-1.65),between surgery group and non-surgery group.Non-surgical treatment could increase larynx preservation rate(RR=0.52,95%CI:0.31-0.87).Conclusion Compared with non-surgical treatment,surgical treatment could improve the overall survival in patient with hypopharyngeal cancer.However,considering the obvious heterogeneity of the related researches,more randomized prospective trials should be performed in the future.