META Analysis Of Clinical Effect Of Radiofrequency Ablation On Early Glottic Carcinoma

ObjectiveMeta-analysis was used to compare and evaluate the efficacy of radiofrequency ablation（RFA）and open partial laryngectomy（OPL）or laser surgery（LS）in the treatment of early glottic carcinoma（EGC）,and to provide evidence-based medical support for the clinical treatment of radiofrequency ablation technology in EGC.MethodsThe databases include Pub Med,Google Scholarthe,Web of Science,EMBASE,Cochrane,CNKI,CBM,Wanfang,VIP and other databases were retrieved using an online computer to obtain the related literature of RFA vs OPL or RFA vs LS treatment for EGC.The relevant literatures searched at the same time were read by two co-authors and conducted strictly in accordance with the inclusion and exclusion criteria,extracting the relevant data from the final included literature that is in line with the research,and use the software Review Manager 5.3 to perform Meta analysis on it.The retrieval time is until December 2019.Resut:A total of 20 studies were included,involving a total of 1332 patients.（1）Local recurrence rate and survival rate after operation:The local recurrence rate at 2 years and 3 years after operation in the RFA group was not significantly different from that in the OPL group,[OR=0.48,95%CI（0.22,1.03）,P=0.06]and[OR=0.88,95%CI（0.38,2.03）,P=0.76];Compared with the LS group,the RFA group had no significant difference in the local recurrence rate at 3 years after operation,[OR=0.80,95%CI（0.35,1.81）,P=0.59].The survival rates of 1 year,2years,3 years,and 5 years after the operation between the RFA and the OPL groups were all not significantly different,and the statistical values had no significant difference,[OR=4.48,95%CI（0.21）,96.01),P=0.34],[OR=1.32,95%CI（0.36,4.87）,P=0.68],[OR=1.96,95%CI（0.98,3.93）,P=0.06],[OR=1.19,95%CI（0.31,4.62）,P=0.80];Compared with the LS group,the 1 year and 3 years survival rates of the RFA group after surgery were not much different,and there was no statistical significance[OR=1.45,95%CI（0.56,3.78）,P=0.45].（2）Vocal analysis:Compared with the OPL group,the F₀ of RFA group had no significant difference,[MD=-4.47,95%CI（-16.86,7.91）,P=0.48].Jitter[MD=-0.15,95%CI（-0.18,-0.12）,P<0.00001],Shimmer[MD=-1.46,95%CI（-1.66,-1.25）,P<0.00001],and HNR[MD=2.17,95%CI（1.65,2.69）,P<0.00001],this three indicators of voice quality were significantly different between RFA group and OPL group.Jitter[MD=-0.06,95%CI（-0.15,0.04）,P=0.23],HNR[MD=-0.87,95%CI（-3.12,1.38）,P=0.45],the two indicators were not significantly different between RFA group and LS group;Shimmer of RFA group was better than that of LS group,and the difference was statistically significant[MD=-0.97,95%CI（-1.08,-0.86）,P<0.00001].（3）Complications:The incidence of vocal cord adhesion[MD=0.33,95%CI（0.13,0.81）,P=0.02],wound infection[MD=0.20,95%CI（0.07,0.55）,P=0.002],breathing and swallowing difficulty[MD=0.33,95%CI（0.15,0.72）,P=0.005],and pharyngeal fistula[MD=0.19,95%CI（0.04,0.89）,P=0.03]in the RFA group was lower than that in the OPL group,and the difference was statistically significant;the incidence of granulation was not significantly different between the RFA group and the OPL group[MD=0.58,95%CI（0.31,1.07）,P=0.08];the difference in the incidence of postoperative bleeding between the RFA group and the OPL group was at the edge of statistical significance[MD=0.42,95%CI（0.18,1.00）,P=0.05],and it needs to be further analyzed after expanding the sample size.Compared with the LS group,the incidence of postoperative complications in the RFA group was not significantly different[OR=1.03,95%CI（0.46,2.31）,P=0.94].Conclusion1.Compared to OPL and LS,RFA has been confirmed a similar therapy result on EGC.2.RFA and LS have relatively fewer complications,better postoperative voice than OPL.3.RFA shows safety and efficacy in the treatment of EGC.