Institute for Clinical Molecular Biology Research, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Republic of Korea.
Medical Affairs Department, Astellas Pharma Europe, Middle East and Africa, Chertsey, United Kingdom.
J Urol. 2017 Feb;197(2):465-479. doi: 10.1016/j.juro.2016.08.100. Epub 2016 Aug 31.
This study attempted to overcome the limitations of previous systematic reviews to determine the overall treatment efficacy and safety of prostatic arterial embolization compared with standard therapy.
Meta-analyses were done of randomized, controlled and single group trials. Meta-regression analysis of the moderator effect was performed with single group analysis. The outcomes measured were mean changes in I-PSS (International Prostate Symptom Score), quality of life, maximal urinary flow rate, prostate volume, post-void residual volume and prostate specific antigen. Adverse events were compared as proportional differences between the embolization group and groups receiving other therapies in comparative studies.
A total of 16 studies met our selection criteria and were included in the meta-analysis. Three studies were comparative and included a total of 297 subjects, including 149 in the experimental groups and 148 in the control groups. The other 13 studies were noncomparative and included a total of 750 experimental subjects. Pooled overall standardized mean differences for embolization in I-PSS, maximal urinary flow rate and prostate volume were significantly impaired in the experimental vs control groups. Overall weighted mean differences for all outcomes except prostate specific antigen were significantly improved from baseline by embolization treatment in noncomparative studies. Sensitivity analysis of study duration showed that all outcome measurements did not differ before vs after 6 months.
Although there is growing evidence of the efficacy and safety of prostatic arterial embolization for benign prostatic hyperplasia, this systematic review using meta-analysis and meta-regression showed that prostatic arterial embolization should still be considered an experimental treatment modality.
本研究试图克服以往系统评价的局限性，以确定前列腺动脉栓塞与标准治疗相比的整体治疗效果和安全性。
对随机对照和单组试验进行了荟萃分析。对单组分析进行了调节效应的元回归分析。测量的结果是国际前列腺症状评分（I-PSS）、生活质量、最大尿流率、前列腺体积、残余尿量和前列腺特异性抗原的平均变化。将栓塞组与接受其他治疗的比较研究组的不良反应进行比例差异比较。
共有 16 项研究符合我们的选择标准，并纳入荟萃分析。3 项研究为对照研究，共纳入 297 例受试者，实验组 149 例，对照组 148 例。另外 13 项研究为非对照研究，共纳入 750 例实验组。与对照组相比，栓塞组的 I-PSS、最大尿流率和前列腺体积的总体标准化均数差异明显受损。非对照研究中，除前列腺特异性抗原外，所有结果的总体加权平均差异均较基线显著改善。对研究持续时间的敏感性分析表明，所有结果的测量在 6 个月前与 6 个月后均无差异。
尽管前列腺动脉栓塞治疗良性前列腺增生的疗效和安全性证据不断增加，但本系统评价使用荟萃分析和元回归显示，前列腺动脉栓塞仍应被视为一种实验性治疗方法。
