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目的:比较术前放疗加手术与单纯手术治疗喉癌的疗效,为喉癌治疗方式的选择提供可靠的循证依据。方法:采用系统评价的方法,检索Co-chrane中心临床对照试验注册数据库、Medline(OVID)、Embase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)以及中文科技期刊全文数据库(VIP),截至2009-11-30,以喉癌患者为研究对象,高质量随机对照研究术前放疗加手术与单纯手术的疗效。结果:共纳入6个随机对照试验,研究对象1 127例。术前放疗加手术与单纯手术相比并未提高喉癌患者的3和5年生存率,RR分别为0.94(95%CI为0.72~1.23)和1.09(95%CI为0.87~1.37)。术前放疗加手术与单纯手术相比治疗声门上型、声门型以及Ⅱ和Ⅲ期喉癌5年生存率,差异均无统计学意义,RR分别为1.02(95%CI为0.79~1.31)、1.01(95%CI为0.61~1.68)、1.10(95%CI为0.65~1.85)和0.85(95% CI为0.37~1.93)。纳入研究均未比较2种治疗后的生存质量。结论:本系统评价纳入研究有限,且无比较2种治疗后生存质量的研究,尚不能得出在喉癌的治疗中术前放疗加手术优于单纯手术治疗疗效的结论。需开展更多高质量研究,对术前放疗加手术与单纯手术治疗喉癌的全面疗效评估提供更可靠的证据。
Objective: To compare the efficacy of preoperative radiotherapy plus surgery and simple surgery in the treatment of laryngeal cancer, and provide a reliable evidence base for the choice of treatment of laryngeal cancer. Methods: We searched the Co-chrane Central Register of Controlled Trials, Medline (OVID), Embase, CBM, CNKI and VIP of Chinese Science and Technology Periodicals ), As of 2009-11-30, laryngeal cancer patients as the research object, high-quality randomized controlled study of preoperative radiotherapy plus surgery and surgery alone. Results: A total of 6 randomized controlled trials were included, with 1 127 subjects. Preoperative radiotherapy plus surgery did not improve 3-year and 5-year survival rates in patients with laryngeal cancer compared with surgery alone, with RRs of 0.94 (95% CI 0.72 to 1.23) and 1.09 (95% CI 0.87 to 1.37), respectively. There was no significant difference in the 5-year survival rate between preoperative radiotherapy and surgery for supraglottic glottic, glottis and stage II and III laryngeal cancer, with RRs of 1.02 (95% CI 0.79 to 1.31 ), 1.01 (95% CI 0.61-1.68), 1.10 (95% CI 0.65-1.85) and 0.85 (95% CI 0.37-1.93). None of the included studies compared the quality of life after 2 treatments. CONCLUSIONS: The systematic review is limited in the research and there is no comparison of the two quality of life after treatment. The conclusion of preoperative radiotherapy and surgical treatment over laryngeal squamous cell carcinoma is better than pure surgical treatment. More high-quality research is needed to provide more reliable evidence of the overall efficacy of preoperative radiotherapy plus surgery and surgery alone in the treatment of laryngeal cancer.