Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
Biosci Rep. 2018 Jan 17;38(1). doi: 10.1042/BSR20171379. Print 2018 Feb 28.
The recommended therapy by EAU guidelines for metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT) with or without chemotherapy. The role of radical prostatectomy (RP) in the treatment of mPCa is still controversial. Hence, a meta-analysis was conducted by comprehensively searching the databases PubMed, EMBASE and Web of Science for the relevant studies published before September 1st, 2017. Our results successfully shed light on the relationship that RP for mPCa was associated with decreased cancer-specific mortality (CSM) (pooled HR = 0.41, 95%CI = 0.36-0.47) and enhanced overall survival (OS) (pooled HR = 0.49, 95%CI = 0.44-0.55). Subsequent stratified analysis demonstrated that no matter how RP compared with no local therapy (NLT) or radiation therapy (RT), it was linked to a lower CSM (pooled HR = 0.36, 95%CI = 0.30-0.43 and pooled HR = 0.56, 95%CI 0.43-0.73, respectively) and a higher OS (pooled HR = 0.49, 95%CI = 0.44-0.56 and pooled HR = 0.46, 95%CI 0.33-0.65, separately). When comparing different levels of Gleason score, M-stage or N-stage, our results indicated that high level of Gleason score, M-stage or N-stage was associated with increased CSM. In summary, the outcomes of the present meta-analysis demonstrated that RP for mPCa was correlated with decreased CSM and enhanced OS in eligible patients of involved studies. In addition, patients with less aggressive tumors and good general health seemed to benefit the most. Moreover, no matter compared with NLT or RT, RP showed significant superiority in OS or CSM. Upcoming prospective randomized controlled trials were warranted to provide more high-quality data.
欧洲泌尿外科学会指南推荐转移性前列腺癌（mPCa）的治疗方法是雄激素剥夺疗法（ADT）联合或不联合化疗。根治性前列腺切除术（RP）在 mPCa 治疗中的作用仍存在争议。因此，我们通过全面检索 PubMed、EMBASE 和 Web of Science 数据库，对截至 2017 年 9 月 1 日之前发表的相关研究进行了荟萃分析。我们的研究结果成功地阐明了 RP 治疗 mPCa 与降低癌症特异性死亡率（CSM）（合并 HR = 0.41，95%CI = 0.36-0.47）和提高总生存率（OS）（合并 HR = 0.49，95%CI = 0.44-0.55）相关。随后的分层分析表明，无论 RP 与局部治疗（NLT）或放疗（RT）相比，都与较低的 CSM（合并 HR = 0.36，95%CI = 0.30-0.43 和合并 HR = 0.56，95%CI 0.43-0.73）和较高的 OS（合并 HR = 0.49，95%CI = 0.44-0.56 和合并 HR = 0.46，95%CI 0.33-0.65）相关。当比较不同的 Gleason 评分、M 分期或 N 分期时，我们的结果表明，高水平的 Gleason 评分、M 分期或 N 分期与 CSM 增加相关。总之，本荟萃分析的结果表明，对于符合条件的研究患者，RP 治疗 mPCa 与降低 CSM 和提高 OS 相关。此外，肿瘤侵袭性较小且总体健康状况良好的患者似乎获益最大。此外，与 NLT 或 RT 相比，RP 在 OS 或 CSM 方面显示出显著优势。需要进行未来的前瞻性随机对照试验，以提供更多高质量的数据。
