This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Initial Surgical versus Non-Surgical treatments for advanced hypopharyngeal cancer: a meta-analysis with trial sequential analysis
Genglong Liu
Affiliated Cancer Hospital of Guangzhou Medical
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9163-4396
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
There is no consensus whether either initial surgical or non-surgical treatments should be the standard treatment pattern to advanced hypopharyngeal cancer. The aim of the meta-analysis was systematically and quantitatively to compare the relative efficacy between initial surgical and non-surgical therapies in patients with advanced-stage hypopharyngeal carcinoma.
Methods
A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to April 10, 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence.
Results
A total of 17 trials was appraised with 2539 patients that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving primary surgical and non-surgical therapy did not significantly differ in overall survival (OS) (relative risk [RR] = 1.04, 95% confidence interval [CI] = 0.94 to 1.15), with TSA inconclusive. Additionally, patients treated with primary surgical experienced an increased disease free survival (DFS) probability compared with non-surgical treatment (RR 1.20, 95% CI=1.05 to1.37), while TSA is inconclusive. Notably, non-surgical management did have a beneficial efficacy on larynx preservation (RR 0.48, 95% CI=0.33 to 0.70), and TSA also provided conclusive evidence. GRADE indicated the level of evidence was low or very low for primary or secondary outcomes.
Conclusion
The results of our meta-analysis indicated compared to surgical treatments, non-surgical therapy for patients with advanced hypopharyngeal carcinoma appear to equivalent efficacy, and it offers an opportunity to preserve laryngeal function. Due to inconclusive evidence by TSA, further investigation with larger randomized clinical trials (RCTs) using modern approaches should be undertaken to verify the results of this meta-analysis.
Keywords
surgical, chemoradiotherapy, advanced hypopharyngeal cancer, survival, trial sequential analysis.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 08 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
This is a preprint. It has not completed peer review.
Research article
Initial Surgical versus Non-Surgical treatments for advanced hypopharyngeal cancer: a meta-analysis with trial sequential analysis
Genglong Liu
Affiliated Cancer Hospital of Guangzhou Medical
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9163-4396
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 08 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
There is no consensus whether either initial surgical or non-surgical treatments should be the standard treatment pattern to advanced hypopharyngeal cancer. The aim of the meta-analysis was systematically and quantitatively to compare the relative efficacy between initial surgical and non-surgical therapies in patients with advanced-stage hypopharyngeal carcinoma.
Methods
A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to April 10, 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence.
Results
A total of 17 trials was appraised with 2539 patients that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving primary surgical and non-surgical therapy did not significantly differ in overall survival (OS) (relative risk [RR] = 1.04, 95% confidence interval [CI] = 0.94 to 1.15), with TSA inconclusive. Additionally, patients treated with primary surgical experienced an increased disease free survival (DFS) probability compared with non-surgical treatment (RR 1.20, 95% CI=1.05 to1.37), while TSA is inconclusive. Notably, non-surgical management did have a beneficial efficacy on larynx preservation (RR 0.48, 95% CI=0.33 to 0.70), and TSA also provided conclusive evidence. GRADE indicated the level of evidence was low or very low for primary or secondary outcomes.
Conclusion
The results of our meta-analysis indicated compared to surgical treatments, non-surgical therapy for patients with advanced hypopharyngeal carcinoma appear to equivalent efficacy, and it offers an opportunity to preserve laryngeal function. Due to inconclusive evidence by TSA, further investigation with larger randomized clinical trials (RCTs) using modern approaches should be undertaken to verify the results of this meta-analysis.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5