Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 of Shuangyong Road, Nanning, 530021, Guangxi, China.
Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Nanning, Nanning, 530021, Guangxi, China.
Lasers Med Sci. 2023 Sep 27;38(1):223. doi: 10.1007/s10103-023-03890-3.
The choice between radiotherapy (RT) and CO laser surgery (CO-LS) for early glottic cancer remains controversial. We systematically examined electronic databases in order to identify prospective trials comparing patients who had undergone CO-LS or RT to treat early glottic cancer. Eleven studies involving 1053 patients were included. In the selected literature, the parameter setting of CO laser equipment can be summarized as wavelength 10.6 µm, superpulsed mode, continuous setting, power tailored on target structures (1-3 W for subtle resections and 4-15 W for cutting a larger tumor), and approximately 2080-3900 W/cm of laser energy. Using RevMan 5.3, we estimated pooled odds ratios (ORs) for dichotomous variables and pooled mean differences (MDs) for continuous variables, along with associated 95% confidence intervals (CIs). The heterogeneity in the treatment variables was measured using Higgins' inconsistency test and expressed as I values. The continuous variables were then depicted as histograms developed using PlotDigitizer 2.6.8. Compared to patients treated with CO-LS, those treated with RT had better jitter (MD 1.27%, 95% CI 1.21 ~ 1.32, P < 0.001), and high scores on the "Grade (MD 6.54, 95% CI 5.31 ~ 7.76, P < 0.001), Breathiness (MD 9.08, 95% CI 4.02 ~ 14.13, P < 0.001), Asthenia (MD 2.13, 95% CI 0.29 ~ 3.98, P = 0.02), and Strain (MD 3.32, 95% CI 0.57 ~ 6.07, P = 0.02)" scale. Patients treated with CO-LS had worse local control rates (OR 3.14, 95% CI 1.52 ~ 6.48, P = 0.002) while lower incidence of second primary tumor (OR 0.30, 95% CI 0.15 ~ 0.61, P < 0.001). It is hoped that retrospective analysis can provide suggestions for early glottis patients to choose personalized treatment.
对于早期声门型喉癌，放疗（RT）与 CO 激光手术（CO-LS）的选择仍存在争议。我们系统地检索了电子数据库，以确定比较 CO-LS 与 RT 治疗早期声门型喉癌患者的前瞻性试验。纳入了 11 项共 1053 例患者的研究。在入选文献中，CO 激光设备的参数设置可总结为波长 10.6µm、超脉冲模式、连续设置、根据目标结构调整功率（细微切除为 1-3W，较大肿瘤切除为 4-15W）以及约 2080-3900W/cm 的激光能量。使用 RevMan 5.3，我们对二分类变量进行了汇总比值比（OR）估计，对连续变量进行了汇总均数差（MD）估计，并附有相应的 95%置信区间（CI）。采用 Higgins 不一致性检验来衡量治疗变量的异质性，并以 I 值表示。然后使用 PlotDigitizer 2.6.8 绘制连续变量的直方图。与 CO-LS 治疗组相比，RT 治疗组的颤搐（MD 1.27%，95%CI 1.211.32，P<0.001）和“嗓音障碍严重程度（MD 6.54，95%CI 5.317.76，P<0.001）、嘶哑（MD 9.08，95%CI 4.0214.13，P<0.001）、无力（MD 2.13，95%CI 0.293.98，P=0.02）和紧张（MD 3.32，95%CI 0.576.07，P=0.02）”量表的评分较高。CO-LS 治疗组的局部控制率较差（OR 3.14，95%CI 1.526.48，P=0.002），而第二原发肿瘤的发生率较低（OR 0.30，95%CI 0.15~0.61，P<0.001）。希望回顾性分析能为早期声门型喉癌患者提供个性化治疗的建议。
