FLEX October 2023

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TABLE II. Modi fi ed Jadad Score for RCTs *

Was the study described as blinded?

Was there a clear description of the inclusion/ exclusion criteria?

Was the method used to assess adverse effects described?

Was the method of statistical analysis described? Score

Was the study

Was the method of randomization appropriate?

Was the method of blinding appropriate?

Was there a description of withdrawals and dropouts?

described as randomized?

Author

Lahav 30 Strieth 32

Yes Yes

Not described

No

No

Yes Yes

Yes Yes

No No

Yes Yes

4 7

Yes

Yes

Yes

* Articles with scores of 4 – 8 indicate good to excellent quality, whereas those with 0 – 3 denote poor to low quality.

control groups in Barbu et al., Murono et al., Parker et al., and Zeitels et al. A detailed report of quality assessment domains, judgments, and justi fi cations are shown in Tables II and III. Because the number of included studies is less than ten, we could not reliably assess the publication bias.

criteria. Disagreements at any stage were resolved by consensus. Two reviewers independently extracted the data from eligible studies into a standardized data collection form. The extracted data included the study ’ s characteristics, risk of bias domains, and study outcomes. We focused in the present systematic review on recurrence rate, retreatment rate, disease-speci fi c and overall survival, grade, roughness, breathiness, asthenia, strain (GRBAS) scale, and voice handicap index (VHI). The risk of bias of randomized controlled trials (RCTs) was assessed using the Modi fi ed Jaded score. Articles with scores of 4 – 8 indicate good to excellent quality, whereas those with 0 – 3 denote poor to low quality. On the other hand, observational studies were assessed using the Newcastle-Ottawa scale. 26 Statistical Analysis Statistical analyses were employed using Stata version 16.0 ( Stata Corp LLC , College Station , TX 77845 , USA ). We ulti mately utilized the random-effects model with the Der-Simonian Liard method. Continuous data (means and standard deviations) were pooled as mean and dichotomous (events and no events) were pooled as percentages with 95% con fi dence intervals (CI). Heterogeneity between studies was inspected visually and statis tically through Chi-square and I 2 tests following Cochrane rec ommendations. Whenever considerable heterogeneity was expected, we performed sensitivity analyses to determine the source of heterogeneity by excluding one study at a time. Eventu ally, publication bias was visually examined through funnel plot symmetry and mathematically through Egger ’ s regression test. RESULTS Search Results and Characteristics of Included Studies Our search retrieved 1,153 unique citations. Of them, 39 records appeared to match the study criteria and were reviewed in detail. The fi nal meta-analysis included eight studies (Figure 1). 6,27 – 33 A total of 342 patients underwent KTP laser ablation within the included studies. All the included studies were performed between 2013 and 2022. Table I summarizes the charac teristics of included patients and studies. The Potential Source of Bias Following the Modi fi ed Oxford Jaded score for RCTs and the NOS for cohort studies, the quality of the included studies ranged from moderate to high. The main concern was the absence of blinding in Lahav et al. and

Outcomes

Functional outcomes Overall survival rate. Eight studies reported the overall survival for patients who underwent KTP ( n = 342 patients), with an average follow-up of 3.3 years. The overall survival after KTP was 90.7% (95% CI 85% – 96.5%). Pooled analysis was substantially heterogeneous ( I 2 = 77%), and heterogeneity did not resolve after further sensitivity analyses, so the random-effects model was employed (Figure 2A). Disease-Free Survival. In the single-arm meta analysis, which included the eight studies ( n = 342 patients), the overall disease-free survival after KTP was 98.5% (95% CI 97.3% – 99.8%). Pooled analysis was homo geneous ( I 2 = 2%, Figure 2B). Recurrence Rate Within the First Year Eight studies reported the recurrence rate within 1 year for patients who underwent KTP ( n = 342 patients). The pooled estimate of KTP recurrence was 8.1% (95% CI 3.3% – 13%); pooled analysis was heteroge nous ( I 2 67%), and did not resolve after further sensitivity analyses, so the random-effects model was employed (Figure 2C). Retreatment Rate Within the First Year Single-arm meta-analysis ( n = 342 patients) showed the retreatment rate with KTP was 12.5% (95% CI 5.5% – 19.5%). Pooled analyses were heterogeneous ( I 2 = 73.5%), and did not resolve after further sensitivity analyses, so the random-effects model was employed (Figure 2D). GRBAS after one-year follow-up. Single-arm meta-analyses ( n = 62patients) of KTP reported a mean reduction from baseline of 3.51 (95% CI [ 0.23, 7.24]). All studies showed comparable baseline score between treat ment modalities. The pooled analyses were heterogeneous ( I 2 = 99.7% and 83.9%), and heterogeneity did not resolve

Laryngoscope 133: August 2023

Suppah et al.: KTP in Glottic Neoplasms 1809