Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, P.R.C.
Curr Oncol. 2019 Feb;26(1):e39-e47. doi: 10.3747/co.26.4203. Epub 2019 Feb 1.
Combined androgen blockade (cab) is a promising treatment modality for prostate cancer (pca). In the present meta-analysis, we compared the efficacy and safety of first-line cab using an antiandrogen (aa) with castration monotherapy in patients with advanced pca.
PubMed, embase, Cochrane, and Google Scholar were searched for randomized controlled trials (rcts) published through 12 December 2016. Hazard ratios (hrs) with 95% confidence intervals (cis) were determined for primary outcomes: overall survival (os) and progression-free survival (pfs). Subgroup analyses were performed for Western compared with Eastern patients and use of a nonsteroidal aa (nsaa) compared with a steroidal aa (saa).
Compared with castration monotherapy, cab using an aa was associated with significantly improved os ( = 14; hr: 0.90; 95% ci: 0.84 to 0.97; = 0.003) and pfs ( = 13; hr: 0.89; 95% ci: 0.80 to 1.00; = 0.04). No significant difference in os ( = 0.71) and pfs ( = 0.49) was observed between the Western and Eastern patients. Compared with castration monotherapy, cab using a nsaa was associated with significantly improved os (hr: 0.88; 95% ci: 0.82 to 0.95; = 0.0009) and pfs (hr: 0.85; 95% ci: 0.73 to 0.98; = 0.007)-a result that was not achieved with cab using a saa. The safety profiles of cab and monotherapy were similar in terms of adverse events, including hot flushes, impotence, and grade 3 or 4 events, with the exception of risk of diarrhea and liver dysfunction or elevation in liver enzymes, which were statistically greater with cab using an aa.
Compared with castration monotherapy, first-line cab therapy with an aa, especially a nsaa, resulted in significantly improved os and pfs, and had an acceptable safety profile in patients with advanced pca.
联合雄激素阻断（cab）是治疗前列腺癌（pca）的一种很有前途的治疗方法。在本荟萃分析中，我们比较了一线使用抗雄激素（aa）的 cab 与去势单药治疗晚期 pca 患者的疗效和安全性。
检索了 2016 年 12 月 12 日之前发表的随机对照试验（rcts）的 PubMed、embase、Cochrane 和 Google Scholar。主要结局的风险比（hrs）和 95%置信区间（cis）为：总生存（os）和无进展生存（pfs）。进行了亚组分析，比较了西方患者与东方患者，以及使用非甾体 aa（nsaa）与甾体 aa（saa）。
与去势单药治疗相比，cab 联合 aa 治疗可显著改善 os（ = 14；hr：0.90；95%ci：0.84 至 0.97； = 0.003）和 pfs（ = 13；hr：0.89；95%ci：0.80 至 1.00； = 0.04）。在西方患者与东方患者之间，os（ = 0.71）和 pfs（ = 0.49）无显著差异。与去势单药治疗相比，cab 联合 nsaa 可显著改善 os（hr：0.88；95%ci：0.82 至 0.95； = 0.0009）和 pfs（hr：0.85；95%ci：0.73 至 0.98； = 0.007），而 cab 联合 saa 则未能达到这一效果。cab 和单药治疗的不良事件安全谱相似，包括热潮红、阳痿和 3 级或 4 级事件，但腹泻和肝功能异常或肝酶升高的风险除外，这些风险在使用 aa 的 cab 中统计学上更高。
与去势单药治疗相比，一线使用 aa 的 cab 治疗，尤其是 nsaa，可显著改善 os 和 pfs，在晚期 pca 患者中具有可接受的安全性。
