1 Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Vulture, Italy.
2 Radiation Oncology Department, Peter MacCallum Cancer Centre, East Bentleigh, Victoria, Australia.
Cancer Biother Radiopharm. 2019 Apr;34(3):141-146. doi: 10.1089/cbr.2018.2702. Epub 2019 Jan 8.
Novel hormonal therapies (NHTs) have enriched the therapeutic armamentarium available for patients with castration-resistant prostate cancer. However, there is a need for clinical indicators able to drive treatment decisions and timing. The aim of this report is to perform a pooled analysis based on all available literature focused on prediction of efficacy and survival in patients treated with NHTs before and postchemotherapy.
After reviewing the studies included in this work, the efficacy and the survival of NHTs according to age and Gleason score (GS) was focused.
A total of eight studies were included in the analysis. With regard to age, the survival hazard ratio shows a better outcome, for both elderly and young patients, in postchemotherapy studies. With regard to progression-free survival, the subgroup analysis of pre- and postchemotherapy studies demonstrates the effect of NHTs on the reduction of risk of progression is greater in prechemotherapy studies irrespective of age. With regard to GS, NHTs show higher efficacy when administered postchemotherapy in patients with GS <8, whereas in patients with GS ≥8 NHTs are more effective in the prechemotherapy setting.
Given the limitations of a meta-analysis of data from the literature, the results show that progression-free survival is always higher when NHTs are administered prechemotherapy in comparison with postchemotherapy. This benefit, however, translates in a reduction of risk of death only in patients with GS ≥8. In the other patients, the risk of death decreases when NHTs are administered postchemotherapy.
新型激素疗法（NHT）丰富了去势抵抗性前列腺癌患者的治疗手段。但是，需要有能够指导治疗决策和时机的临床指标。本报告的目的是基于所有关于 NHT 治疗化疗前后疗效和生存预测的文献进行汇总分析。
在回顾了本研究中包含的研究后，重点关注了 NHT 根据年龄和 Gleason 评分（GS）的疗效和生存情况。
共纳入 8 项研究进行分析。就年龄而言，与化疗后研究相比，化疗前研究的生存风险比显示出更好的结果，无论是老年患者还是年轻患者。就无进展生存而言，化疗前和化疗后研究的亚组分析表明，NHT 对降低进展风险的作用在化疗前研究中更大，而与年龄无关。就 GS 而言，在 GS<8 的患者中，NHT 在后化疗时更有效，而在 GS≥8 的患者中，NHT 在化疗前更有效。
鉴于对文献数据进行荟萃分析的局限性，结果表明，与化疗后相比，化疗前给予 NHT 时无进展生存始终更高。然而，这种益处仅在 GS≥8 的患者中转化为降低死亡风险。在其他患者中，当给予 NHT 时，死亡风险会降低。
