Brungs D, Chen J, Masson P, Epstein R J
1] Department of Oncology, Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia [2] Clinical Informatics and Research Centre, Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, Sydney, NSW, Australia.
Department of Oncology, St George Hospital, Sydney, NSW, Australia.
Prostate Cancer Prostatic Dis. 2014 Jun;17(2):105-11. doi: 10.1038/pcan.2014.10. Epub 2014 Apr 1.
The optimal hormone treatment strategy in prostate cancer is uncertain, particularly in patients with metastatic disease. We aimed to compare the relative benefits and harms of intermittent androgen deprivation (IAD) to continuous androgen deprivation (CAD) in all stages of prostate cancer.
We included eight randomised control trials (4668 patients) in our systematic review and meta-analysis. Median follow-up ranged from 29 to 118 months. Pooled hazard ratios (HRs) were calculated for overall survival (OS), cancer-specific survival, time to cancer progression and mortality unrelated to prostate cancer. The relative effect of treatment in patients with metastatic and those with non-metastatic disease was compared using pre-planned subgroup analysis.
There was no difference in OS between patients treated with IAD and CAD (HR 1.01, 95% confidence interval (CI) 0.93-1.10); nor was there any difference in cancer-specific survival (HR 1.03; 95% CI 0.88-1.21). There was a non-significant trend towards longer time to prostate cancer progression for IAD (HR 0.93, 95% CI 0.84-1.04), raising the possibility of slower selection for castrate resistance. There was no significant difference in OS when analysis was restricted to patients with metastatic disease (HR 1.04, 95% CI 0.91-1.19) or patients without metastatic disease (HR 1.06, 95% CI 0.91-1.23) (test for subgroup differences P=0.84). Most studies found an improvement in quality of life or toxicity profile with IAD.
IAD is non-inferior to CAD in terms of OS and cancer-specific survival, and is at least non-inferior in terms of time to progression. This meta-analysis confirms IAD as a valid standard of care for managing prostate cancer patients.
前列腺癌的最佳激素治疗策略尚不确定，尤其是在转移性疾病患者中。我们旨在比较间歇性雄激素剥夺（IAD）与持续性雄激素剥夺（CAD）在前列腺癌各阶段的相对益处和危害。
我们在系统评价和荟萃分析中纳入了八项随机对照试验（4668例患者）。中位随访时间为29至118个月。计算总生存期（OS）、癌症特异性生存期、癌症进展时间和与前列腺癌无关的死亡率的合并风险比（HR）。使用预先计划的亚组分析比较转移性疾病患者和非转移性疾病患者的治疗相对效果。
接受IAD和CAD治疗的患者在OS方面没有差异（HR 1.01，95%置信区间（CI）0.93 - 1.10）；癌症特异性生存期也没有差异（HR 1.03；95% CI 0.88 - 1.21）。IAD组前列腺癌进展时间有延长的非显著趋势（HR 0.93，95% CI 0.84 - 1.04）增加了出现去势抵抗选择较慢的可能性。当分析仅限于转移性疾病患者（HR 1.04，95% CI 0.91 - 1.19）或无转移性疾病患者（HR 1.06，95% CI 0.91 - 1.23）时，OS没有显著差异（亚组差异检验P = 0.84）。大多数研究发现IAD可改善生活质量或毒性特征。
在OS和癌症特异性生存期方面，IAD不劣于CAD，且在进展时间方面至少不劣于CAD。这项荟萃分析证实IAD是管理前列腺癌患者的有效护理标准。
