经口激光显微手术与放射治疗在早期声门型喉癌中疗效比较的Meta分析

发布时间：2018-06-14 18:25

本文选题：经口激光手术 + 放射治疗　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过Meta分析的方法,对比评估经口激光显微手术(TLM)和放射治疗(RT)对于早期声门型喉癌的临床疗效,为临床上制定早期声门癌的治疗方案提供循证学依据。方法:通过PubMed、EMBASE、the Cochrane Library、Web of knowledge、Google Scholarthe、the Wiley online library、中国知网、万方数据库、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)检索有关激光手术与放射治疗早期声门型喉癌的全部文献。通过制定纳入标准及排除标准,对文献进行筛选、质量评价,选定最终纳入研究的文献,并提取相关评价指标的数据。运用RevMan5.3软件对数据进行Meta分析,二分类变量资料采用OR值、95%CI表示效应量,以患者的局部复发率(LR)、总体生存率(OS)、局部控制率(LC)、喉保存率(LP)、并发症发生率(CR)、死亡率(MR)作为观察指标,对比分析两种治疗方法的疗效。结果:经文献筛选,最终选定18篇符合要求的文献,均为观察性非随机对照试验。共纳入2397个研究对象,经口激光显微手术(TLM)组1165例,放射治疗(RT)组1232例。Meta分析结果显示:(1)局部复发率(LR)的比较:共纳入9篇文献,研究对象1240例,其中TLM组539例,RT组701例。TLM组与RT组的LR无统计学差异[OR=1.04,95%CI(0.72,1.51)Z=0.20,P=0.84]。(2)局部控制率(LC)的比较:共纳入14篇文献,研究对象总计1830例,其中TLM组876例,RT组954例。TLM组与RT组在肿瘤局部控制方面无统计学意义[OR=1.14,95%CI(0.86,1.51),Z=0.92,P=0.36]。(3)5年总生存率(OS)的比较:共有11篇文献纳入研究,参加病例数总计1597例,其中TLM组713例,RT组884例。TLM组与RT组的5年总生存率有统计学意义[OR=1.31,95%CI(1.00,1.70),Z=1.97,P=0.05]。(4)喉保存率(LP)比较:共有13篇文献纳入研究,病例数总计1995例,其中TLM组977例,RT组1018例。TLM组与RT组在喉器官保存率上有显著统计学差异[OR=4.41,95%CI(2.81,6.94),Z=6.44,P0.00001]。(5)并发症(CR)的比较:共有4篇文献纳入研究,病例数总计513例,其中TLM组184例,RT组329例。有中度异质性,不能合并。通过敏感性分析,引起异质性的研究数据来自Spector JG(1999),并且是权重最大的文章,去掉其重新Meta分析,结果显示:TLM组与RT组在并发症发生率方面没有统计学意义[OR=0.50,95%CI(0.18,1.40),Z=1.31,P=0.19]。(6)死亡率(MR)的比较:共有8篇文献纳入研究,病例数总计1293例,其中TLM组615例,RT组678例。TLM组与RT组的死亡率有统计学差异[OR=0.57,95%CI(0.38,0.85),Z=2.77,P=0.006]。结论:(1)在局部复发、肿瘤的局部控制方面,经口激光手术与放射治疗可以获得相似的治疗效果。(2)经口激光手术的患者5年总生存率优于放射治疗,死亡率明显低于放射治疗。(3)经口激光手术的喉保存率高于放射治疗。(4)经口激光手术与放射治疗在并发症发生率方面无明显差异。
[Abstract]:Objective: to evaluate the clinical efficacy of transoral laser microsurgery (TLM) and radiotherapy (RTT) in the treatment of early glottic laryngeal carcinoma by meta-analysis, and to provide evidence based basis for clinical treatment of early glottic carcinoma. Methods: the whole literature on laser surgery and radiotherapy for early glottic laryngeal carcinoma was searched by PubMedine EMBASEN the Cochrane Library of knowledge online the Wiley online library. China knowledge Web, Wanfang Database, Chinese Biomedical Literature Database, Chinese Journal of Science and Technology Full-text Database (VIPs). Through the establishment of inclusion criteria and exclusion criteria, the literature was screened, the quality evaluated, the documents that were included in the study were selected, and the data of relevant evaluation indexes were extracted. The data were analyzed by RevMan5.3 software. The data were classified by OR value (95 CI). The local recurrence rate (LRR), overall survival rate, local control rate (LC), laryngeal retention rate (LPN), complication rate (CRN), mortality rate (MRR) were used as indicators. Compare and analyze the curative effect of two kinds of treatment methods. Results: after literature screening, 18 articles were selected, all of which were observational non-randomized controlled trials. A total of 2397 subjects were included, 1165 cases in the oral laser microsurgery group and 1232 cases in the radiotherapy group. The results of Meta-analysis showed that the local recurrence rate (LRR) was higher than that in the control group: a total of 9 articles were included, and 1240 cases were included in the study. There was no significant difference in LR between TLM group (n = 701) and RT group (n = 701). There was no significant difference in LR between TLM group and RT group. There were 954 cases in TLM group and 954 cases in RT group. There was no significant difference in local tumor control between TLM group and RT group. There were significant differences in 5-year overall survival rate between TLM group (713 cases) and RT group (884 cases). There was significant difference in 5-year survival rate between TLM group and RT group. There were significant differences in the survival rate of laryngeal organs between TLM group (1018 cases) and RT group (1018 cases). There was a significant difference in the survival rate of laryngeal organs between TLM group and RT group (OR4.41 ~ 95CIA 2.81 ~ 6.94 ~ 6.94) (P 0.00001). A total of 4 articles were included in the study, the total number of cases was 513 cases, including 184 cases of TLM group and 329 cases of RT group (n = 329). There is moderate heterogeneity and cannot be combined. By sensitivity analysis, the data that led to heterogeneity came from Spector JGG 1999 and were the most weighted articles, and removed its remeta-analysis. The results showed that there was no significant difference in the incidence of complications between the two groups. There were significant differences in mortality between TLM group (678 cases) and RT group (678 cases). Conclusion (1) in local recurrence and local control of tumor, the curative effect of oral laser surgery and radiotherapy can be similar. 2) the 5-year overall survival rate of patients undergoing oral laser surgery is better than that of radiotherapy. Mortality was significantly lower than that of radiotherapy. 3) the survival rate of larynx in laser surgery was higher than that in radiotherapy. 4) there was no significant difference in the incidence of complications between oral laser surgery and radiotherapy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.65

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