前列腺癌患者的男性乳房发育：一项系统综述
Gynecomastia in Patients with Prostate Cancer: A Systematic Review.
作者信息
Fagerlund Anders, Cormio Luigi, Palangi Lina, Lewin Richard, Santanelli di Pompeo Fabio, Elander Anna, Selvaggi Gennaro
机构信息
Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
出版信息
PLoS One. 2015 Aug 26;10(8):e0136094. doi: 10.1371/journal.pone.0136094. eCollection 2015.
INTRODUCTION
Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients' quality of life.
AIMS
To systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients' quality of life.
METHODS
The PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:"gynecomastia AND treatment AND prostate cancer". Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design) process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE.
MAIN OUTCOME MEASURES
Primary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life.
RESULTS
Eleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high.
CONCLUSIONS
Bicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10-20 mg daily) or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy.
引言
男性乳房发育症和/或乳腺疼痛是接受抗雄激素（比卡鲁胺或氟他胺）治疗前列腺癌的患者中常见的医学问题；这些患者中高达70%会受到影响；此外，这会危及患者的生活质量。
目的
系统评价当前文献中关于比卡鲁胺所致男性乳房发育症治疗方案的证据质量，包括疗效、安全性和患者生活质量。
方法
在2000年1月1日至2014年12月31日期间系统检索了PubMed、Medline、Scopus、Cochrane图书馆和SveMed+数据库。所有检索均在2015年1月至2月进行。使用的检索词为：“男性乳房发育症 与 治疗 与 前列腺癌”。两名评审员评估了所识别出的762篇标题和摘要。检索和评审过程按照PRISMA声明进行。采用PICOS（患者、干预措施、对照、结局和研究设计）流程来明确纳入标准。根据GRADE对证据质量进行评级。
主要结局指标
主要结局为：治疗效果、并发症和副作用的数量。次要结局为：生活质量。
结果
11项研究符合纳入标准并在本综述中进行分析。5项研究报告了他莫昔芬和/或阿那曲唑的药物干预，作为预防性或治疗性治疗。4项研究报告了放射治疗作为预防性和/或治疗性治疗。2项研究比较了药物治疗与放射治疗。大多数研究为随机对照研究，存在不同程度的偏倚风险。根据GRADE，证据质量为中等到高。
结论
比卡鲁胺所致男性乳房发育症和/或乳腺疼痛可通过口服他莫昔芬（每日10 - 20毫克）或放射治疗有效控制，且无相关副作用。他莫昔芬的预防性或治疗性治疗比放射治疗更有效。
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