Department of Otorhinolaryngology, Binzhou Medical University Hospital, No. 661 Second Huanghe Road, Binzhou, 256603, Shandong, China.
BMC Cancer. 2019 Mar 29;19(1):282. doi: 10.1186/s12885-019-5412-z.
Hypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages. Yet which treatment is the most efficacious one still remain unanswered. This network meta-analysis (NMA) was conducted to investigate effectiveness of six therapies being utilized in clinical practice nowadays.
PubMed and Embase were retrieved to synthesize data. Direct and indirect evidence was combined to compare efficacy of treatments. A relative ranking of the six regimens was calculated by the surface under the curve ranking area (SUCRA).
A total of 28 trials with 9109 patients were included in our NMA. Five endpoints investigated included 3/5-year overall survival (3/5-OS), 3/5-year disease free survival (3/5-DFS) and 5-year overall survival rate (5-OSR). In terms of all efficacy outcomes, radiotherapy combined with surgery (RT + S) proved to be better than other therapies while radiotherapy (RT) alone also performed well. Induction chemoradiotherapy (ICRT) was the best regarding 3-DFS (SUCRA = 0.846) while current chemoradiotherapy (CCRT) ranked first in 5-DFS (SUCRA = 0.933) according to SUCRA results. No significant differences were demonstrated in 5-DFS and 5-OSR as shown in the results of NMA.
RT combined with surgery turned out to be optimal therapy of all the outcomes while the efficacy of RT was relatively poorer in the treatment of patients with larynx stage III-IV and hypopharynx stage II-IV. Also, the good performance of CCRT and ICRT in terms of DFS made them as secondary recommended therapies. There is no significant difference between surgery and transoral laser microsurgery (TLM) alone.
下咽和喉肿瘤均具有致命性且难以早期发现。然而，哪种治疗方法最有效仍未得到解答。本网络荟萃分析（NMA）旨在研究目前临床实践中使用的六种疗法的有效性。
检索 PubMed 和 Embase 以综合数据。结合直接和间接证据来比较治疗效果。通过曲线下面积排序区域（SUCRA）计算六种方案的相对排名。
共纳入 28 项试验，包含 9109 例患者。五项研究终点包括 3/5 年总生存率（3/5-OS）、3/5 年无病生存率（3/5-DFS）和 5 年总生存率（5-OSR）。在所有疗效指标中，放疗联合手术（RT+S）优于其他疗法，而单纯放疗（RT）也表现良好。诱导放化疗（ICRT）在 3-DFS 方面最佳（SUCRA=0.846），而当前放化疗（CCRT）在 5-DFS 方面排名第一（SUCRA=0.933）。NMA 结果表明，5-DFS 和 5-OSR 无显著差异。
RT 联合手术是所有结果的最佳治疗方法，而 RT 对喉癌 III-IV 期和下咽癌 II-IV 期患者的疗效相对较差。此外，CCRT 和 ICRT 在 DFS 方面的良好表现使它们成为二线推荐治疗方法。手术和单纯经口激光微创手术（TLM）之间无显著差异。
