Chen Junru, Zhang Xingming, Sun Guangxi, Zhao Jinge, Liu Jiandong, Zhao Peng, Dai Jindong, Shen Pengfei, Zeng Hao
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China,
Onco Targets Ther. 2018 Dec 13;11:9061-9070. doi: 10.2147/OTT.S187239. eCollection 2018.
The role of additional chemotherapy in the treatment of high-risk prostate cancer (PCa) remains a controversy. This meta-analysis aimed to investigate the effect of additional chemotherapy on high-risk PCa.
Randomized controlled trials (RCTs) about additional chemotherapy for high-risk PCa were searched in PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. We extracted HRs of overall survival (OS) and progression-free survival (PFS) for each trial and performed the meta-analysis using Review Manager 5.3.
Eight RCTs involving 4,007 patients were included. Data from four trials, which could collect OS, showed that additional chemotherapy could not significantly improve the OS in patients with high-risk PCa (HR: 0.93; 95% CI: 0.79-1.09; =0.37). However, the pooled analysis suggested significantly longer PFS in high-risk PCa patients treated with additional chemotherapy (HR: 0.81; 95% CI: 0.74-0.90; <0.0001). The meta-analysis showed additional chemotherapy to androgen-deprivation therapy improved PFS (HR: 0.82; 95% CI: 0.74-0.91; =0.0002). Greater improvement in PFS was found in high-risk PCa patients treated with additional docetaxel-based chemotherapy (HR: 0.73; 95% CI: 0.64-0.83; <0.00001). No prolonged PFS was observed in high-risk PCa patients with non-docetaxel-based chemotherapy (HR: 0.97; 95% CI: 0.83-1.14; =0.74).
Additional chemotherapy, especially docetaxel-based chemotherapy, could significantly improve the PFS in high-risk PCa patients. More evidence about the effect of additional chemotherapy on OS is needed. Further investigations in PCa should also focus on the suitable population for chemotherapy as well as optimal use of chemotherapy.
辅助化疗在高危前列腺癌（PCa）治疗中的作用仍存在争议。本荟萃分析旨在探讨辅助化疗对高危PCa的疗效。
在PubMed、MEDLINE、EMBASE和Cochrane对照试验中央注册库中检索关于高危PCa辅助化疗的随机对照试验（RCT）。我们提取每个试验的总生存期（OS）和无进展生存期（PFS）的风险比（HR），并使用Review Manager 5.3进行荟萃分析。
纳入了8项涉及4007例患者的RCT。四项可收集OS数据的试验表明，辅助化疗并不能显著改善高危PCa患者的OS（HR：0.93；95%置信区间：0.79-1.09；P=0.37）。然而，汇总分析表明，接受辅助化疗的高危PCa患者的PFS显著延长（HR：0.81；95%置信区间：0.74-0.90；P<0.0001）。荟萃分析表明，辅助化疗联合雄激素剥夺治疗可改善PFS（HR：0.82；95%置信区间：0.74-0.91；P=0.0002）。接受基于多西他赛的辅助化疗的高危PCa患者的PFS改善更为显著（HR：0.73；95%置信区间：0.64-0.83；P<0.00001）。接受非多西他赛化疗的高危PCa患者未观察到PFS延长（HR：0.97；95%置信区间：0.83-1.14；P=0.74）。
辅助化疗，尤其是基于多西他赛的化疗，可显著改善高危PCa患者的PFS。需要更多关于辅助化疗对OS影响的证据。PCa的进一步研究还应关注化疗的合适人群以及化疗的最佳使用。
