| Objective:By means of meta-analysis,the long-term efficacy and preservation rate of laryngeal function of combined surgical and non-surgical therapy for advanced hypopharyngeal cancer were compared,and the best treatment mode for advanced hypopharyngeal cancer was explored to provide evidence-based medical support for clinical decision-making.Methods:Systematic comprehensive search of PubMed/Medline database,Springerlink,The Cochrane Library,Wanfang database,China Journal Full-text Database(CNKI),Chinese Science and Technology Periodical Database(VIP)from 1990 to December 2018(nearly30 years)A published case-control study of combined surgical and non-surgical treatment of advanced hypopharyngeal cancer.The literature was rigorously screened by established inclusion and exclusion criteria,and the quality of the successfully screened literature were scored using the Newcastle-Ottawa Scale and improved Jadad scale,and the basic information of the literature and the data needed for the study were extracted.Meta-analysis was performed using RevMan5.3 software.The odds ratio(OR)and 95%confidence interval(95% CI)were used as the effect size.The corresponding effect pattern was selected according to the results of the heterogeneity test.The 3-year overall survival rate,5-year overall survival rate,complication rate,laryngeal function preservation rate,5-year local control rate and 5-year local recurrence-free survival rate were used as indicators to compare the prognosis of the two regimens.Results:Finally,a total of 13 articles,1 randomized controlled trial and 12 retrospectivecase-control studies were included,with a total of 1994 subjects.Among them,720 patients underwent surgical comprehensive treatment(SRT)and 1274 patients underwent non-surgical comprehensive treatment(CRT).Meta-analysis showed that:(1)Total 3-year survival rate was 1035 subjects,282 in SRT group and 753 in CRT group.There was no significant difference between the two groups in total 3-year survival rate [OR = 1.14,95% CI(0.62,2.06),P = 0.68].(2)5-year overall survival rate: a total of 1069 subjects,480 patients in SRT group and 589 patients in CRT group.There were significant differences in 5-year overall survival rates between the two groups [OR = 1.40,95% CI(1.08,1.81),Z = 2.55,P = 0.01].(3)Laryngeal function preservation rate: A total of 395 subjects were studied,153 in SRT group and242 in CRT group.There were significant differences in the preservation rate of laryngeal function between the two groups [OR = 0.03,95% CI(0.01,0.07),Z = 7.87,P < 0.00001](4)5-year local control rate: 452 subjects,222 in SRT group and 230 in CRT group.There was significant difference between the two groups in 5-year local control rate[OR=0.87,0.07,Z=7,P<0.00001].= 2.26,95% CI(1.51,3.40),Z = 4.09,P < 0.0001].(5)5-year local recurrence-free survival rate: 452 subjects were studied,222 in SRT group and 230 in CRT group.There was significant difference in 5-year local recurrence-free survival rate between the two groups [OR = 1.68,95% CI(1.11,2.55),Z = 2.46,P =0.01].Conclusion:The 5-year overall survival rate,5-year local recurrence-free survival rate and5-year local control rate of SRT group were better than those of CRT group,while the preservation rate of laryngeal function was lower than that of CRT group.This study found that surgery-based comprehensive treatment strategy is better for locally advanced resectable hypopharyngeal cancer. |
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