Serrell Emily C, Pitts Daniel, Hayn Matthew, Beaule Lisa, Hansen Moritz H, Sammon Jesse D
Tufts University School of Medicine, Boston, MA.
Division of Urology, Maine Medical Center, Portland, MA.
Urol Oncol. 2018 Apr;36(4):183-192. doi: 10.1016/j.urolonc.2017.10.003. Epub 2017 Nov 6.
Evidence regarding the effectiveness of treatment for prostate cancer is primarily based on randomized controlled trials. Long-term outcomes are generally difficult to evaluate within experimental studies and may benefit from large pools of observational data. We conducted a systematic review of administrative and registry studies to evaluate the comparative effectiveness of treatment for clinically localized prostate cancer on overall and prostate-cancer specific mortality.
In accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P, 2015), we conducted a systematic search of Ovid Medline and Embase (1946-February 2017) and identified studies that evaluated the relationship between types of treatment for localized prostate cancer and mortality. Additional articles were identified through manual search. Randomized, prospective, and single institution studies were excluded. The risk of bias for each study was evaluated with the Newcastle Ottawa scale. Multivariable adjusted hazard ratios were reported to evaluate overall and cancer-specific mortality.
We screened 4,721 studies and included for review, 19 that were published between 2001 and 2015. The pooled population included 228,444 patients. Countries of origin included the United States, Canada, China, Switzerland, the Netherlands, and Sweden, and the sources included administrative (n = 6) and cancer registry or prostate databases (n = 11). Overall and cancer-specific mortality were lowest among definitive treatment arms as compared to conservative therapy with no treatment, observation, or active surveillance. Radiotherapy was associated with worse overall and cancer-specific mortality than radical prostatectomy.
Although observational studies using large, population-based cohorts have the potential for bias, we found consistent evidence that high-quality observational studies may be used to evaluate the comparative effectiveness of prostate cancer treatment. Methodologic limitations of observational data should be considered.
关于前列腺癌治疗效果的证据主要基于随机对照试验。长期结果在实验研究中通常难以评估，可能受益于大量观察性数据。我们对行政和登记研究进行了系统评价，以评估临床局限性前列腺癌治疗对总体死亡率和前列腺癌特异性死亡率的比较效果。
根据系统评价和荟萃分析方案的首选报告项目（PRISMA-P，2015），我们对Ovid Medline和Embase（1946年 - 2017年2月）进行了系统检索，并确定了评估局限性前列腺癌治疗类型与死亡率之间关系的研究。通过手动检索确定了其他文章。排除随机、前瞻性和单机构研究。使用纽卡斯尔渥太华量表评估每项研究的偏倚风险。报告多变量调整后的风险比以评估总体死亡率和癌症特异性死亡率。
我们筛选了4721项研究，纳入了2001年至2015年间发表的19项研究进行综述。汇总人群包括228,444名患者。原产国包括美国、加拿大、中国、瑞士、荷兰和瑞典，数据来源包括行政数据（n = 6）和癌症登记或前列腺数据库（n = 11）。与不治疗、观察或主动监测的保守治疗相比，确定性治疗组的总体死亡率和癌症特异性死亡率最低。放射治疗与根治性前列腺切除术相比，总体死亡率和癌症特异性死亡率更高。
尽管使用基于人群的大型队列的观察性研究存在偏倚的可能性，但我们发现一致的证据表明，高质量的观察性研究可用于评估前列腺癌治疗的比较效果。应考虑观察性数据的方法学局限性。
