Qasem Mustafa, Qasem Noor, Kinshuck Andrew, Milinis Kristijonas
Head and Neck Department, Liverpool University Hospitals NHS Trust, Liverpool, UK.
Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Otolaryngol Head Neck Surg. 2025 Feb;172(2):375-385. doi: 10.1002/ohn.1011. Epub 2024 Oct 15.
To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer.
A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024.
Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters.
There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I = 74.94; P < .001). The risk of bias was assessed to be serious.
The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.
回顾关于早期声门癌患者接受经口激光显微手术（TLM）与放射治疗（RT）后的长期功能结局和生活质量（QoL）的文献。
从数据库建立至2024年4月，在PubMed、Scopus和Cochrane图书馆进行了系统检索。
纳入的文章为直接比较T1和T2声门癌患者中这两种治疗方式的主要研究。关注的结局为嗓音功能和生活质量的患者报告结局指标（PROMs）、临床医生报告的指标以及声学分析参数。
TLM组和RT组在分级、粗糙度、气息声、无力感、紧张度方面无显著差异（相对风险，1.11；95%置信区间[CI]，0.60 - 2.07；I = 90.96；P <.001），在嗓音障碍指数-30评分方面无显著差异（标准化均数差[SME] 0.51；95% CI，-0.04 - 1.07；I = 89.72；P <.001），在基频方面也无显著差异（SME 0.56；95% CI，-0.14 - 1.25；I = 91.12；P <.001）。TLM组在抖动（SME 0.54；95% CI，0.08 - 1.00；I = 79.42；P <.001）和闪烁（SME 0.53；95% CI，0.11 - 0.95；I = 74.94；P <.001）方面表现显著更好。偏倚风险评估为严重。
研究结果表明，在早期声门癌治疗中，TLM和RT的长期PROMs相当，TLM在声学分析结果方面表现更好。然而，现有证据仍然稀少，异质性高且存在偏倚风险。需要通过大型随机对照试验对TLM和RT进行直接比较，以提供更充分的证据来确定最佳治疗方案。
