经口显微手术治疗T3/T4a期喉肿瘤的生存结果：系统评价和Meta分析

Survival Outcomes of Transoral Microsurgery in T3/T4a Laryngeal Tumors: Systematic Review and Meta-Analysis.

作者信息

Vasudevan Srivatsa Surya, Zulli Adam, Olinde Lindsay, Pang John, Nathan Cherie-Ann O, Asarkar Ameya A

机构信息

Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.

Department of Surgery, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana, USA.

出版信息

Laryngoscope. 2025 Jan;135(1):15-26. doi: 10.1002/lary.31695. Epub 2024 Aug 14.

DOI:10.1002/lary.31695

PMID:39140205

Abstract

OBJECTIVE

To critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3/T4a glottic and supraglottic squamous cell carcinoma (SCC).

DATA SOURCES

A comprehensive search of five major databases-PubMed, Embase, Scopus, ScienceDirect, and Web of Science-was conducted using a combination of relevant keywords and MeSH terms.

REVIEW METHODS

Systematic review and meta-analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3/T4a glottic and supraglottic tumors. A random-effects meta-analysis model was employed.

RESULTS

The review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3/T4a glottic and supraglottic SCC. The cumulative 5-year disease-free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47-66%) and 62.8% (95% CI: 63-81%), while the 5-year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4-49.2%) and 32.9% (95% CI: 19.3-50.1%), respectively. T3 glottic tumors exhibited a 2.5-fold significantly higher odds of local recurrence post-TLM compared to their T3 supraglottic tumors (95% CI: 1.6-3.9, p < 0.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7-83.8%) and 88.4% (95% CI: 79.4-93.8%), respectively. Both groups showed comparable rates of tracheostomy (p = 0.48) and gastrostomy performed (p = 0.17).

CONCLUSIONS

This meta-analysis suggests that TLM is a viable larynx preservation approach in select patients with T3/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:15-26, 2025.

摘要

目的

严格评估经口激光显微手术（TLM）治疗T3/T4a期声门型和声门上型鳞状细胞癌（SCC）患者的肿瘤学和功能学结局。

数据来源

使用相关关键词和医学主题词（MeSH）组合对五个主要数据库——PubMed、Embase、Scopus、ScienceDirect和Web of Science进行全面检索。

综述方法

对优势比（OR）、风险比（HR）和比例进行系统评价和荟萃分析，重点关注TLM治疗晚期T3/T4a期声门型和声门上型肿瘤的肿瘤学和功能学结局。采用随机效应荟萃分析模型。

结果

该综述纳入了29项队列研究，共1897例接受TLM治疗的T3/T4a期声门型和声门上型SCC患者。T3期声门型和声门上型肿瘤的5年累积无病生存率（DFS）分别为44.4%（95%CI：47 - 66%）和62.8%（95%CI：63 - 81%），而T4期声门型和声门上型肿瘤的5年DFS分别为41.1%（95%CI：33.4 - 49.2%）和32.9%（95%CI：19.3 - 50.1%）。与T3期声门上型肿瘤相比，T3期声门型肿瘤TLM术后局部复发的优势比显著高2.5倍（95%CI：1.6 - 3.9，p < 0.0001）。T3期声门型和声门上型肿瘤的喉保留率分别为68.9%（95%CI：48.7 - 83.8%）和88.4%（95%CI：79.4 - 93.8%）。两组的气管造口术（p = 0.48）和胃造口术施行率（p = 0.17）相当。