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A comparison of the survival between laser surgery and radiation in T1aN0M0 glottic cancer: a population-based analysis and meta-analysis

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

The objective of this study is to compare the overall survival (OS) and the cancer-specific survival (CSS) for patients of T1aN0M0 glottic cancer who underwent laser surgery (LS) or radiation (RT).

Methods

The data of the population-based analysis were extracted from the SEER database. The studies of the meta-analysis were identified through PubMed, EMBASE, and Cochrane databases. Cox regression analyses, the propensity score analysis (PSM), survival analyses, and the meta-analysis were performed.

Results

In the population-based analysis, 2101 eligible patients were included. Multivariable Cox analyses indicated that patients accepting LS alone would obtain better OS (HR 0.77, 95% CI 0.61–0.98, p = 0.03) and CSS (HR 0.26, 95% CI 0.12–0.59, p = 0.001) than those of whom they accepted RT alone. Survival analyses before PSM and after PSM also indicated that patients who underwent LS alone would have better OS and CSS. In the meta-analysis, nine eligible studies were included. Results of the pooled effect showed that significant differences existed between LS and RT groups on OS (OR: 1.84, 95% CI 1.36–2.50, p < 0.001) and CSS (OR 3.84, 95% CI 1.17–12.52, p = 0.026), both distinctly favoring LS.

Conclusions

Compared with RT, LS may acquire better survivals for patients with T1aN0M0 glottic cancer. Simultaneously, more multi-center randomized controlled trials would be warranted to prove the conclusion.

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References

  1. Pfister DG, Spencer S, Adelstein D et al (2022) NCCN clinical practice guidelines in oncology: head and neck cancers (version 1, 2022). https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 2 Feb 2022

  2. Machiels JP, René Leemans C, Golusinski W et al (2020) Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 31:1462–1475

    Article  Google Scholar 

  3. Forastiere AA, Ismaila N, Lewin JS et al (2018) use of larynx-preservation strategies in the treatment of laryngeal cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol 36:1143–1169

    Article  Google Scholar 

  4. Goor KM, Peeters AJ, Mahieu HF et al (2007) Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality. Head Neck 29:128–136

    Article  Google Scholar 

  5. Sjogren EV, Langeveld TP, Baatenburg DJR (2008) Clinical outcome of T1 glottic carcinoma since the introduction of endoscopic CO2 laser surgery as treatment option. Head Neck 30:1167–1174

    Article  Google Scholar 

  6. Thurnher D, Erovic BM, Frommlet F et al (2008) Challenging a dogma-surgery yields superior long-term results for T1a squamous cell carcinoma of the glottic larynx compared to radiotherapy. Euro J Surg Oncol 34:692–698

    Article  CAS  Google Scholar 

  7. Schrijvers ML, van Riel EL, Langendijk JA et al (2009) Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head Neck 31:759–764

    Article  Google Scholar 

  8. Mahler V, Boysen M, Brøndbo K (2010) Radiotherapy or CO2 laser surgery as treatment of T1a glottic carcinoma? Eur Arch Otorhinolaryngol 267:743–750

    Article  Google Scholar 

  9. Remmelts AJ, Hoebers FJP, Klop WMC et al (2013) Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice. Eur Arch Otorhinolaryngol 270:2079–2087

    Article  CAS  Google Scholar 

  10. Laoufi S, Mirghani H, Janot F, Hartl DM (2014) Voice quality after treatment of T1a glottic cancer. Laryngoscope 124:1398–1401

    Article  Google Scholar 

  11. Alkan U, Nachalon Y, Shkedy Y et al (2017) T1 squamous cell carcinoma of the glottis with anterior commissure involvement: radiotherapy versus transoral laser microsurgery. Head Neck 39:1101–1105

    Article  Google Scholar 

  12. Low TH, Yeh D, Zhang T et al (2017) Evaluating organ preservation outcome as treatment endpoint for T1aN0 glottic cancer. Laryngoscope 127:1322–1327

    Article  Google Scholar 

  13. Forner D, Rigby MH, Hart RD, Trites JR, Taylor SM (2019) Oncological and functional outcomes following transoral laser microsurgery in patients with T2a vs T2b glottic squamous cell carcinoma. J Otolaryngol Head Neck Surg 48:27

    Article  Google Scholar 

  14. Mendenhall WM, Strojan P, Lee A et al (2020) Radiotherapy in the management of glottic squamous cell carcinoma. Head Neck 42:3558–3567

    Article  Google Scholar 

  15. Warner L, Chudasama J, Kelly CG et al (2014) Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002027

    Article  PubMed  PubMed Central  Google Scholar 

  16. Huang G, Luo M, Zhang J, Liu H (2017) Laser surgery versus radiotherapy for T1a glottic carcinoma: a meta-analysis of oncologic outcomes. Acta Otolaryngol 137:1204–1209

    Article  Google Scholar 

  17. Katz SJ (2015) Cancer care delivery research and the national cancer institute SEER program: challenges and opportunities. JAMA Oncol 1:677–678

    Article  Google Scholar 

  18. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM (2017) Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317:1338–1348

    Article  Google Scholar 

  19. Morgan CJ (2018) Reducing bias using propensity score matching. J Nucl Cardiol 25:404–406

    Article  Google Scholar 

  20. Renehan AG, Malcomson L, Emsley R et al (2016) Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol 17:174–183

    Article  Google Scholar 

  21. Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457

    Article  Google Scholar 

  22. Bledsoe TJ, Park HS, Stahl JM et al (2017) Hypofractionated radiotherapy for patients with early-stage glottic cancer: patterns of care and survival. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djx042

    Article  PubMed  Google Scholar 

  23. Steuer CE, El-Deiry M, Parks JR, Higgins KA, Saba NF (2017) An update on larynx cancer. CA Cancer J Clin 67:31–50

    Article  Google Scholar 

  24. Chung SY, Lee CG (2020) Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer. Head Neck 42:854–859

    Article  Google Scholar 

  25. Nomiya T, Nemoto K, Wada H, Takai Y, Yamada S (2008) Long-term results of radiotherapy for T1a and T1bN0M0 glottic carcinoma. Laryngoscope 118:1417–1421

    Article  CAS  Google Scholar 

  26. Canis M, Ihler F, Martin A, Matthias C, Steiner W (2015) Transoral laser microsurgery for T1a glottic cancer: review of 404 cases. Head Neck 37:889–895

    Article  Google Scholar 

  27. Zhang Y, Wang B, Sun G et al (2018) Carbon dioxide laser microsurgery versus low-temperature plasma radiofrequency ablation for t1a glottic cancer: a single-blind randomized clinical trial. Biomed Res Int 2018:4295960

    Article  Google Scholar 

  28. Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB (2004) Management of T1–T2 glottic carcinomas. Cancer 100:1786–1792

    Article  Google Scholar 

  29. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A (2009) Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 266:1333–1352

    Article  Google Scholar 

  30. Landolfo V, Gervasio CF, Riva G et al (2016) Prognostic role of margin status in open and CO2 laser cordectomy for T1a–T1b glottic cancer. Braz J Otorhinolaryngol 84:74–81

    Article  Google Scholar 

  31. Murono S, Endo K, Kondo S, Wakisaka N, Yoshizaki T (2013) Oncological and functional outcome after transoral 532-nm pulsed potassium-titanyl-phosphate laser surgery for T1a glottic carcinoma. Laser Med Sci 28:615–619

    Article  Google Scholar 

  32. Higgins KM (2011) What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 121:116–134

    Article  Google Scholar 

  33. Fakhry N, Vergez S, Baumstarck K et al (2015) Multicentric evaluation of strategies for treatment of T1a glottic carcinomas. Eur Arch Otorhinolaryngol 272:143–148

    Article  Google Scholar 

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Acknowledgements

We are grateful to Dr. Hui-Zi Li for his technical support.

Author information

Author notes

  1. Guan-Jiang Huang and Meng-Si Luo contributed equally to this paper.

Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China

    Guan-Jiang Huang

  2. Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China

    Meng-Si Luo

  3. Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China

    Hong-Bing Liu

Authors
  1. Guan-Jiang Huang
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  2. Meng-Si Luo
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Contributions

G-JH and H-BL performed the conception and designed this manuscript. G-JH and M-SL performed data analysis and prepared the figure. G-JH and M-SL drafted the manuscript. H-BL revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hong-Bing Liu.

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The authors declare no conflicts of interest in the work.

Ethical approval.

Ethics approval or patient written informed consent were not required because all analyses in our study were performed based on data from the public databases (the SEER database, PubMed, EMBASE, and Cochrane databases).

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Huang, GJ., Luo, MS. & Liu, HB. A comparison of the survival between laser surgery and radiation in T1aN0M0 glottic cancer: a population-based analysis and meta-analysis. Eur Arch Otorhinolaryngol 279, 5299–5310 (2022). https://doi.org/10.1007/s00405-022-07450-3

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  • DOI: https://doi.org/10.1007/s00405-022-07450-3

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