| Objective:By means of Meta-analysis method,assessing the treatment effect of transoral laser microsurgery(TLM)versus radiotherapy(RT)for early glottic carcinoma,in order to provide evidence-based medicine for clinical treatment of early glottic cancer.Methods:Searching PubMed,EMBASE,the Cochrane Library,Web of knowledge,Google Scholar,the Wiley online library,CNKI,Wanfang database,Chinese biomedical literature database(CBM),Full-text Database of Chinese Sci-tech Journals(VIP)to obtain all the literature about TLM and RT for early glottic carcinoma at home and abroad.Through the regulations of inclusion criteria and exclusion criteria,completing the literature screening and quality evaluation of literature,selecting the final inclusion of the literature,and extracting the relevant indicators of the data.At the same time,using RevMan 5.3software for Meta analysis about related literature according included and excluded standards.The searching time ended up to December,2016.Results:After literature screening,18 articles were selected,which were all non randomized controlled trials.A total of 2397 subjects were included in the study.The patients were treated with transoral laser microsurgery(TLM)in 1165 cases,and radiotherapy(RT)in1232 cases.Meta analysis showed that:(1)Local Recurrence rate(LR)comparison: a total of 9papers,1240 cases of subjects,including TLM group 539 cases,RT group 701 cases.There was no significant difference between TLM group and RT group [OR=1.04,95%CI(0.72,1.51)Z=0.20,P=0.84].(2)Local Control rate(LC)comparison: A total of 14 articles were included in the study,1830 cases of subjects,including 876 cases of TLM group and 954 cases of RT group.TLM group and RT group has no statistically significant difference in tumor Local Control [OR = 1.14,95% CI(0.86,1.51),Z = 0.92,P = 0.36].(3)5-year Overall Survival rate(OS)comparison: a total of 11 articles into the study,the total number of cases participated in 1597 cases,of which 713 cases of TLM group,884 cases of RT group.The 5-year Overall Survival rate of TLM group and RT group has statistically significant differences[OR = 1.31,95% CI(1.00,1.70),Z = 1.97,P= 0.05].(4)Laryngeal Preservation rate(LP)comparison: A total of 13 articles were included in the study,the total number of cases in 1995 cases,including 977 cases of TLM group,RT group 1018 cases.There was significant differences in the Laryngeal Preservation rate between TLM group and RT group[OR = 4.41,95% CI(2.81,6.94),Z =6.44,P <0.00001].(5)Complication Rate(CR)comparison: a total of 4 articles into the study,the total number of cases participated in 513 cases,of which 184 cases of TLM group,RT group 329 cases.Moderate heterogeneity can not be combined.Through the analysis of sensitivity,heterogeneity of the study data from Spector JG(1999),and is the largest weight of the article,remove it and the re-meta analysis,the results showed: TLM group and RT group in the incidence of complications was not statistically significant[OR = 0.50,95% CI(0.18,1.40),Z= 1.31,P = 0.19].(6)Mortality Rate(MR)comparison:a total of 8 articles into the study,the total number of cases of 1293 cases,including TLM group 615 cases,RT group 678 cases.There was a significant difference between the TLM group and the RT group [OR = 0.57,95% CI(0.38,0.85),Z = 2.77,P = 0.006].Conclusion:(1)In the treatment of local recurrence(LR)and local control(LC)of the tumor,the same curative effect can be obtained by transoral laser microsurgery(TLM)andradiotherapy(RT).(2)The 5-year overall survival rate(OS)of patients undergoing transoral laser microsurgery(TLM)was better than that of radiotherapy(RT),and the mortality rate(MR)was significantly lower than that of radiotherapy(RT).(3)The laryngeal preservation(LP)of transoral laser microsurgery(TLM)was significantly higher than that of radiotherapy(RT).(4)There was no significant difference in the incidence of complication rate between transoral laser microsurgery(TLM)and radiotherapy(RT). |
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