晚期下咽癌手术综合疗法与非手术综合疗法两种治疗策略疗效比较的Meta分析  

Meta-analysis of comparison for efficacies between surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced hypopharyngeal cancer

作　　者：樊佳敏 温树信[2,4] 王斌全 皇甫辉[2] 翟雪松[1] 赵晓娟 Fan Jiamin;Wen Shuxin;Wang Binquan;Huangfu Hui;Zhai Xuesong;Zhao Xiaojuan(the First Clinical College of Shanxi Medical University,Taiyuan 030001,China;Department of Otorhinolaryngology Head and Neck Surgery,the First Hospital of Shanxi Medical University.Taiyuan 030001,China;Department of Otorhinolaryngology Head and Neck Surgery,Datong Coal Mine Group General Hospital,Datong 037000,China;Department of Otorhinolaryngology Head and Neck Surgery,Shenzhen University,General Hospital.Shenzhen 518055,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院耳鼻咽喉头颈外科,太原030001 [3]大同煤矿集团总医院耳鼻咽喉头颈外科,大同037000 [4]深圳大学总医院耳鼻咽喉头颈外科,518055

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第2期144-149,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的使用Meta分析的方法,比较手术综合疗法[surgery plus radio(chemo)therapy,SRT]与非手术综合疗法(non-surgery chemoradiotherapy,CRT)在治疗晚期下咽癌患者中的远期疗效及喉功能保存率。方法检索PubMed、the Cochrane Library、万方数据库、中国期刊全文数据库、中文科技期刊数据库中公开发表的关于手术综合疗法与非手术综合疗法治疗晚期下咽癌病例对照研究的文献。检索语言限定为中文和英文,时间段为1990年至2018年,通过制定的纳入与排除标准对文献进行严格筛选,提取本研究所需要的数据,采用RevMan 5.3软件进行Meta分析。结果共纳入13篇文献,整体文献质量相对较高,未提示明显发表偏倚。共1994例受试者,其中SRT组720例,CRT组1274例。SRT组与CRT组的平均3年总生存率分别为42.9%与44.8%,差异无统计学意义(OR=1.14,95%CI:0.62~2.06,P=0.68)。SRT组的平均5年总生存率(OR=1.42,95%CI:1.10~1.84,P<0.01)、5年局部无复发生存率(OR=1.68,95%CI:1.11~2.55,P=0.01)及5年局部控制率(OR=2.17,95%CI:1.52~3.12,P<0.01)分别为46.4%、47.4%及71.2%均高于CRT组(分别为37.9%、32.0%及52.2%),平均喉功能保存率为19.8%低于CRT组的80.6%,差异有统计学意义(OR=0.03,95%CI:0.01~0.07,P<0.01)。结论本研究发现SRT远期疗效更好,CRT的喉功能保存效果更佳。Objective Meta-analysis was used to compare the long-term efficacy and laryngeal function preservation rate of patients with advanced hypopharyngeal cancer treated with surgery plus radio(chemo)therapy(SRT)or non-surgery chemoradiotherapy(CRT).Methods We searched publicly published articles on case-control studies of surgical and non-surgical comprehensive treatment of advanced hypopharyngeal cancer in PubMed,the Cochrane Library,Wanfang Database,Chinese Journal Full-text Database,and Chinese Science and Technology Periodical Database.The search language was limited to Chinese and English,and the period was from 1990 to 2018.These literatures were rigorously screened by inclusion and exclusion criteria.The data needed for this study were extracted and the Meta analysis was performed using RevMan 5.3 software.Results A total of 13 literatures were included,and the overall quality of the literature was relatively high,and no significant publication bias was suggested.A total of 1994 subjects,including 720 in the SRT group and 1274 in the CRT group.The average 3-year overall survival rates were 42.9%in SRT group and 44.8%in CRT group,with no significant difference(OR=1.14,95%CI:0.62-2.06,P=0.68).The average 5-year overall survival rate(OR=1.42,95%CI:1.10-1.84,P<0.01),5-year local recurrence-free survival rate(OR=1.68,95%CI:1.11-2.55,P=0.01)and 5-year local control rate(OR=2.17,95%CI:1.52-3.12,P<0.01)of SRT group were 46.4%,47.4%and 71.2%,respectively,which were higher than those of non-surgical group(37.9%,32.0%,and 52.2%respectively).The average laryngeal function preservation rate was 19.8%,being significantly lower than 80.6%of the non-surgical group(OR=0.03,95%CI:0.01-0.07,P<0.01).Conclusions SRT has better long-term efficacy,while CRT has better preservation of laryngeal function.

关 键 词：下咽肿瘤 外科手术 放射疗法 综合疗法 META分析 

分 类 号：R73[医药卫生—肿瘤]