早期声门癌治疗方法的meta分析

发布时间：2018-05-11 06:00

本文选题：喉癌 + 声门癌　；参考：《广西医科大学》2011年硕士论文

【摘要】：目的:人们对早期声门癌初次选择的治疗方案有争议。通过本研究,为临床上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MEDLINE(1966～2010)、EMBASE (1984～2010)、Cochrane图书馆、中国生物医学文献光盘数据库(1979～2010)、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XRT vs TOL研究中,在并发症发生率方面,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。在复发率和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,体外放射治疗(external radiation, XRT)与内镜下激光治疗(transoral laser,TOL)差异无统计学意义,但结果仍倾向于TOL较XRT有更少的复发和更高的局部控制。而在死亡率、总生存率、喉保留率方面,纳入文献异质性较小,进行合并后,得出在这三个方面,内镜下激光治疗与放射治疗后的结果相比更具优越性。在XRT vs SUR研究中,在复发率、死亡率、5年总生存率、5年局部控制率方面,纳入文献异质性较小,进行合并后,得出在这四个方面,传统手术治疗(SUR)更具优越性,与体外放射治疗(XRT)后的结果相比,差异有统计学意义。在喉保留率方面,纳入文献存在较显著异质性,采用亚组分析后,XRT与SUR差异无统计学意义。在并发症发生率方面,该研究证据强度低,是否可信有待进一步研究。结论:内镜下激光治疗的疗程简单,甚至在门诊即可完成,而且花费相对便宜,有显著的优越性,故,相比放射治疗,激光治疗可作为早期声门癌优先选择的治疗方案。但对于肿瘤较大,侵犯前联合的患者,还未有明确结论,根据文献资料,建议首选传统手术治疗。因为本研究中纳入的数据都是回顾性研究,故需要增加更多的科学、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。
[Abstract]:Objective: the first choice of treatment for early glottic carcinoma is controversial. This study provides evidence for the selection of treatment methods for early glottic carcinoma. Methods: the electronic retrieval database MEDLINE (1966 / 2010) was used to search the EMBASE library, the Chinese Biomedical document CD-ROM database (1979 / 2010), the full text database of Chinese academic journals (1994 / 2010), the full text database of Chinese scientific and technological periodicals (19892010), the Chinese biomedical journal database (1994 / 2010) and the Wanfang database. The OR value was calculated by RevMan5.0. Results: in the XRT vs TOL study, the incidence of complications, because of the inclusion of significant heterogeneity in the literature, if the use of meta analysis may lead to wrong results, so the use of meta analysis was abandoned. There was significant heterogeneity in recurrence rate and 5-year local control rate. After eliminating heterogeneity or using subgroup analysis, there was no significant difference between external radiotherapy (XRTs) and endoscopic laser therapy for transoral laser therapy. But the results still tend to have less recurrence and higher local control in TOL than in XRT. However, the mortality, overall survival rate and laryngeal retention rate were less heterogeneous. After combining, the results of endoscopic laser therapy were more superior than that of radiotherapy. In the XRT vs SUR study, in the aspects of recurrence rate, mortality rate, 5-year overall survival rate and 5-year local control rate, the heterogeneity of literature was small. After combining, it was concluded that the traditional surgical treatment had more advantages in these four aspects. The difference was statistically significant compared with the results after external radiation therapy (XRT). In terms of laryngeal retention rate, there was significant heterogeneity in the included literature. There was no significant difference between XRT and SUR after subgroup analysis. In terms of incidence of complications, the evidence for this study is low, and whether it is credible remains to be further studied. Conclusion: the course of laser therapy under endoscope is simple, even in outpatient service, and the cost is relatively cheap and has obvious advantages. Therefore, laser therapy can be used as a preferential treatment for early glottic carcinoma compared with radiotherapy. However, there is no clear conclusion for the patients with large tumor and pre-invasion. According to the literature, the first choice of traditional surgical treatment is suggested. Since the data included in this study are retrospective studies, more scientific and rigorous research data or results of randomized controlled trials are needed to reach a more scientific conclusion.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.65

【参考文献】