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Meta-Analysis
. 2016 Apr;95(14):e3142.
doi: 10.1097/MD.0000000000003142.

Efficacy Comparison Between Total Laryngectomy and Nonsurgical Organ-Preservation Modalities in Treatment of Advanced Stage Laryngeal Cancer: A Meta-Analysis

Xiaoyuan Fu  1 , Qi Zhou, Xianquan Zhang
Affiliations
Meta-Analysis

Efficacy Comparison Between Total Laryngectomy and Nonsurgical Organ-Preservation Modalities in Treatment of Advanced Stage Laryngeal Cancer: A Meta-Analysis

Xiaoyuan Fu et al. Medicine (Baltimore). 2016 Apr.

Abstract

It remains unclear whether the efficacy of nonsurgical organ-preservation modalities (NOP) in the treatment of advanced-stage laryngeal cancer was noninferiority compared with that of total laryngectomy (TL). The objective of this study was to compare the curative effects between TL and NOP in the treatment of advanced-stage laryngeal cancer through a meta-analysis.Clinical studies were retrieved from the electronic databases of PubMed, Embase, Wanfang, and Chinese National Knowledge infrastructure. A meta-analysis was performed to investigate the differences in the curative efficacy of advanced-stage laryngeal cancer between TL and the nonsurgical method. Two reviewers screened all titles and abstracts, and independently assessed all articles. All identified studies were retrospective.Sixteen retrospective studies involving 8308 patients (4478 in the TL group and 3701 in the nonsurgical group) were included in this meta-analysis. The analysis results displayed the advantage of TL for 2-year and 5-year overall survival (OS)(OR 2.79, 95% CI 1.85-4.23 and OR 1.52, 95% CI 1.09-2.14) as well as in 5-year disease-specific survival (DSS)(OR 1.79, 95% CI 1.61-1.98), but no significant difference in 2-year DSS was detected between the 2 groups (OR = 2.09,95% CI0.69-6.40). Additionally, there were no significant differences between TL and NOP for 5-year local control (LC) either (OR = 1.75, 95% CI 0.87-3.53). When we carried out subgroup analyses, the advantage of TL was especially obvious in T4 subgroups, but not in T3 subgroups.This is the first study to compare the curative effects on advanced-stage laryngeal cancer using meta-analytic methodology. Although there was a trend in favor of TL for OS and DSS, there is no clear difference in oncologic outcome between TL and NOP. Therefore, other factors such as tumor T-stage and size, lymph node metastasis, and physical condition are also important indicators for treatment choice.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart for study selecting.
FIGURE 2
FIGURE 2
Comparison of overall survival (2-year overall survival, A; 5-year overall survival, B) between total laryngectomy (TL) and nonsurgical organ-preservation modalities (NOP). CI = confidence interval; NOP = nonsurgical organ-preservation; OR = odds ratio; TL = total laryngectomy.
FIGURE 3
FIGURE 3
Comparison between the treatment groups for T4 (2-year overall survival for T4, A; 5-year overall survival for T4, B)and T3 (2-year overall survival for T3, C; 5-year overall survival for T3, D) overall survival. CI = confidence interval; OR = odds ratio.
FIGURE 4
FIGURE 4
Comparison between the treatment groups for disease-specific survival (2-year disease-specific survival, A; 5-year disease-specific survival, B; 5-year disease-specific survival forT3, C). CI = confidence interval; OR = odds ratio.
FIGURE 5
FIGURE 5
Comparison between the treatment groups for local control (2-year local control, A; 5-year local control, B). CI = confidence interval; OR = odds ratio.
FIGURE 6
FIGURE 6
Funnel plot for publication bias.
See this image and copyright information in PMC

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