{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:55:04Z","timestamp":1781524504967,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early\u2010stage glottic carcinoma is characterized by high cure rate, but about 10% of patients still develop local recurrence after radiotherapy (RT). Although advances in local therapies have markedly improved larynx preservation, anterior commissure involvement (ACI) may worsen outcomes yet remains insufficient to fully guide personalized treatment. Here, we conducted a univariate meta\u2010analysis and a Bayesian multivariate meta\u2010analysis of multiple factors (MVMA\u2010MF) to evaluate the prognostic impact of ACI and on local failure in early\u2010stage glottic carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review with univariate meta\u2010analysis and MVMA\u2010MF using data from studies of early\u2010stage glottic carcinoma treated with definitive RT, incorporating clinical information, risk factors and survival outcomes. A systematic literature search was conducted in PubMed and Scopus on Sep 27, 2025. Eligible studies provided sufficient data to estimate odds ratios (ORs) for local control in relation to patient, tumor and treatment factors, including ACI. Data extraction followed PRISMA guidelines, and study quality was assessed using MINORS criteria. The primary endpoint of the study was the effect of ACI on local failure. Pooled ORs were calculated with a random\u2010effects model, and heterogeneity was assessed using the Cochrane\n                      <jats:italic>Q<\/jats:italic>\n                      test and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic. To address correlations among risk factors, we applied a Bayesian multivariate meta\u2010analysis of multiple factors (MVMA\u2010MF), testing three models (H, M0, U) with Markov Chain Monte Carlo algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Nine clinical trials representing 2527 patients were included. In univariate meta\u2010analysis, the presence of ACI was significantly associated with an increased risk of local recurrence in early\u2010stage glottic carcinoma treated with RT (OR 1.61, 95% CI 1.15\u20132.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), with moderate heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200934%). In MVMA\u2010MF including 14 risk factors, only T substage demonstrated a consistent and statistically significant association with recurrence across all models. ACI, smoking status and other risk factors showed non\u2010significant associations, with wide credible intervals overlapping unity. Correlation analysis revealed mostly low\u2010to\u2010moderate inter\u2010variable correlations, supporting the multivariable modeling approach. Comparison of univariate and multivariate estimates for ACI indicated that the unadjusted analysis suggested increased recurrence risk, whereas adjusted models yielded attenuated and non\u2010significant associations (adjusted ORs 1.05\u20131.43, all 95% CrIs including unity).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>This study represents the first application of both univariate and multivariate meta\u2010analysis to clarify the prognostic role of ACI in early\u2010stage glottic carcinoma treated with definitive RT. While univariate analysis suggested ACI increased recurrence risk, this effect was not confirmed in MVMA\u2010MF, indicating the univariate findings may be confounded by correlation with other factors, particularly T substage. MVMA\u2010MF approach accounted for heterogeneity, collinearity and incomplete reporting, providing more robust evidence. This work underscores the value of advanced multivariate methods in oncology meta\u2010analysis and provides the strongest evidence to date that ACI should not be regarded as a fundamental prognostic criterion in early\u2010stage glottic carcinoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70219","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:17:21Z","timestamp":1772993841000},"page":"1383-1390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Impact of Anterior Commissure Involvement on Treatment Failure in Early\u2010Stage Glottic Carcinoma Treated With Definitive Radiotherapy: A Univariate and Multivariate Meta\u2010Analysis"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-8358","authenticated-orcid":false,"given":"Francesca","family":"De Felice","sequence":"first","affiliation":[{"name":"Radiation Oncology, AOU Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences \u201cSapienza\u201d University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Passalacqua","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences \u201cSapienza\u201d University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Sanguineti","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit IRCCS Regina Elena National Cancer Institute  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(25)00020-8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2016.10.013"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1293"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00932"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21860"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.06.014"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12139"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/030089160409000310"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2016.503"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2015.11.005"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0385-8146(99)00072-3"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-023-07904-2"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28395"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23504"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12061485"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0330389"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26186"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70219","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70219","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70219","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:28:01Z","timestamp":1781522881000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/hed.70219"],"URL":"https:\/\/doi.org\/10.1002\/hed.70219","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]},"assertion":[{"value":"2025-12-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}