Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical Center, New York, New York.
Clin Gastroenterol Hepatol. 2019 Jun;17(7):1253-1264.e5. doi: 10.1016/j.cgh.2018.10.028. Epub 2018 Oct 24.
BACKGROUND & AIMS: Gastric reflux may lead to chronic mucosal inflammation and contribute to development of laryngeal malignancies, although there is controversy over this association. We performed a systematic review and meta-analysis to assess this relationship and determine the risk of laryngeal malignancy in patients with reflux disease.
We performed a systematic review and meta-analysis, searching MEDLINE, EMBASE, and Web of Science databases from 1900 through April 9, 2018, for observational studies of adults reporting associations between gastroesophageal reflux disease (GERD) and/or laryngopharyngeal reflux and the risk of having or developing laryngeal malignancies. An itemized assessment of the risk of bias was conducted for each study that met inclusion criteria. The meta-analysis was performed using the Mantel-Haenszel method with random effects to account for heterogeneity. We performed subgroup analyses to determine the effect of reflux type, study design, diagnostic method, and confounding variables on the overall risk.
Of the 957 studies that were identified during systematic review, 18 case-control studies met the criteria for analysis. Our meta-analysis showed that reflux disease significantly increased the risk of laryngeal malignancy (odds ratio, 2.47; 95% CI, 1.90-3.21; P < .00001; I = 94%). This association remained when controlling for patient smoking and drinking (odds ratio, 2.07; 95% CI, 1.26-3.41). There was no statistically significant difference in risk of laryngeal malignancies between patients with GERD vs laryngopharyngeal reflux (P = .44).
In a systematic review and meta-analysis, we found a significant association between reflux disease and the presence of laryngeal malignancy. Prospective studies should be performed to examine this relationship.
胃食管反流可能导致慢性黏膜炎症，并促进喉恶性肿瘤的发展，尽管对此关联存在争议。我们进行了一项系统评价和荟萃分析，以评估这种相关性，并确定反流性疾病患者发生喉恶性肿瘤的风险。
我们进行了一项系统评价和荟萃分析，检索了 MEDLINE、EMBASE 和 Web of Science 数据库，时间从 1900 年至 2018 年 4 月 9 日，以获取报告胃食管反流病（GERD）和/或喉咽反流与发生或发展为喉恶性肿瘤风险之间关联的成人观察性研究。对符合纳入标准的每项研究进行了风险偏倚的分项评估。使用固定效应模型进行荟萃分析，以解释异质性。我们进行了亚组分析，以确定反流类型、研究设计、诊断方法和混杂变量对总体风险的影响。
在系统评价中，共确定了 957 项研究，其中 18 项病例对照研究符合分析标准。我们的荟萃分析表明，反流性疾病显著增加了发生喉恶性肿瘤的风险（比值比，2.47；95%CI，1.90-3.21；P<0.00001；I=94%）。在控制患者吸烟和饮酒因素后，这种关联仍然存在（比值比，2.07；95%CI，1.26-3.41）。GERD 与喉咽反流患者发生喉恶性肿瘤的风险之间无统计学差异（P=0.44）。
在一项系统评价和荟萃分析中，我们发现反流性疾病与喉恶性肿瘤的存在之间存在显著相关性。应进行前瞻性研究来进一步检验这种关系。
