The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
Clin Transl Oncol. 2019 Sep;21(9):1152-1158. doi: 10.1007/s12094-019-02036-8. Epub 2019 Jan 16.
With the maturity of cryotherapy for prostate cancer, the complications after operation are also decreasing, which can improve the prognosis of patients. However, erectile dysfunction (ED) is still one of the main complications after cryotherapy. Therefore, we performed a meta-analysis to evaluate the incidence of erectile dysfunction in patients after cryotherapy.
A comprehensive literature search was performed in August 2018. PUBMED and EMBASE databases were searched to collect studies reporting the incidence rate of ED after cryotherapy from 2002 to 2018. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of included studies. Pooled ratio and its 95% confidence intervals (95% CIs) were performed by Stata 12.1.
Of the 157 articles identified on August 1st 2018, 23 studies which reported ED after cold ablative therapy were identified, however, only 12 used validated outcome measures and met inclusion criteria. A total of 12 studies were included in this meta-analysis. Overall, the results of this meta-analysis showed that the pooled incidence rate of ED was 0.27 (95% CI 0.26-0.28) which means that the incidence rate of ED after cryotherapy for prostate cancer was not high, but we still found that there are great heterogeneity between the 12 articles. By subgroup analysis, we found a statistically significant incidence rate of ED in primarily localized PCa which was 0.49 (95% CI 0.30-0.68), which is clearly lower than the incidence of recurrent prostate cancer after failed primary radiotherapy 0.61 (95% CI 0.43-0.79).
ED is one of the major complications after cryotherapy for PCa. Furthermore, subgroup analysis revealed a higher incidence rate in PCa undergoing radiotherapy. Significantly, with the development of cryotherapy technology, the incidence of ED after cryotherapy for prostate cancer is decreasing. While we still need further researches to advance knowledge in this field.
随着前列腺癌冷冻治疗的成熟，术后并发症也在减少，这可以改善患者的预后。然而，勃起功能障碍（ED）仍然是冷冻治疗后的主要并发症之一。因此，我们进行了一项荟萃分析，以评估冷冻治疗后患者发生 ED 的情况。
我们于 2018 年 8 月进行了全面的文献检索。检索了 PUBMED 和 EMBASE 数据库，以收集 2002 年至 2018 年间报道冷冻治疗后 ED 发生率的研究。两名审查员独立筛选文献、提取数据并评估纳入研究的偏倚风险。采用 Stata 12.1 进行汇总比及其 95%置信区间（95%CI）。
在 2018 年 8 月 1 日确定的 157 篇文章中，有 23 篇文章报道了冷消融治疗后的 ED，但是，只有 12 篇文章使用了经过验证的结局测量方法并符合纳入标准。共有 12 项研究纳入了这项荟萃分析。总体而言，这项荟萃分析的结果显示，ED 的总发生率为 0.27（95%CI 0.26-0.28），这意味着前列腺癌冷冻治疗后 ED 的发生率并不高，但我们仍发现 12 篇文章之间存在很大的异质性。通过亚组分析，我们发现原发性局限性前列腺癌的 ED 发生率具有统计学意义，为 0.49（95%CI 0.30-0.68），明显低于初次放疗失败后复发前列腺癌的发生率 0.61（95%CI 0.43-0.79）。
ED 是前列腺癌冷冻治疗后的主要并发症之一。此外，亚组分析显示，接受放疗的前列腺癌患者 ED 发生率更高。重要的是，随着冷冻治疗技术的发展，前列腺癌冷冻治疗后 ED 的发生率正在下降。虽然我们仍需要进一步的研究来推进这一领域的知识。
