Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Int J Surg. 2019 Jun;66:28-36. doi: 10.1016/j.ijsu.2019.04.006. Epub 2019 Apr 17.
Although androgen deprivation therapy with or without chemotherapy are currently the mainstay of therapy for metastatic prostate cancer, accumulating data suggested the survival benefits from definitive local therapy such as radical prostatectomy or radiation therapy. Hence, this network meta-analysis was aimed to provide a hierarchy of different therapeutic regimens for mPCa.
Relevant studies were retrieved comprehensively by searching the online databases of PubMed, EMBASE and Web of Science, published before July 1st, 2018. With the help of R-3.4.0 software and "gemtc-0.8.2" package, network meta-analysis was performed by random-effect model within a Bayesian framework. Hazard ratios and corresponding 95% credible intervals were calculated by Markov chain Monte Carlo methods. The surface under the cumulative ranking curve was also incorporated to rank the corresponding therapeutic regimens.
A total of 55,363 cases from 17 studies were ultimately involved in this study. Ten different therapeutic regimens and three clinical endpoints were finally assessed. As illustrated by our results, local therapy (such as radical prostatectomy or radiation therapy) could provide a relatively more favorable survival rate than systematic therapies (no local therapy, androgen deprivation therapy or androgen deprivation therapy + chemotherapy). Meanwhile, in the comparison of radiation therapy, brachytherapy and intensity modulated radiation therapy were among the best two therapies. Furthermore, radical prostatectomy had a relatively lower cancer specific mortality or all-cause mortality than brachytherapy or intensity modulated radiation therapy, in the comparison of local therapy, whereas brachytherapy showed a relatively longer overall survival than radical prostatectomy.
Our results indicated that local therapy was better than no local therapy. In a comprehensive comparison of three clinical endpoints (overall survival, cancer specific mortality or all-cause mortality), radical prostatectomy had a relatively lower cancer specific mortality or all-cause mortality than radiation therapy, whereas brachytherapy was superior to radical prostatectomy for overall survival.
尽管去势治疗联合或不联合化疗目前是转移性前列腺癌的主要治疗方法，但越来越多的数据表明根治性局部治疗（如前列腺根治术或放疗）具有生存获益。因此，本网络荟萃分析旨在为 mPCa 提供不同治疗方案的层级。
通过搜索在线数据库 PubMed、EMBASE 和 Web of Science，全面检索了截至 2018 年 7 月 1 日之前发表的相关研究。借助 R-3.4.0 软件和“gemtc-0.8.2”包，采用随机效应模型在贝叶斯框架内进行网络荟萃分析。通过马尔可夫链蒙特卡罗方法计算风险比及其相应的 95%可信区间。还纳入了累积排序曲线下面积来对相应的治疗方案进行排序。
共有来自 17 项研究的 55,363 例患者最终纳入本研究。最终评估了 10 种不同的治疗方案和 3 个临床终点。结果表明，局部治疗（如前列腺根治术或放疗）比系统治疗（无局部治疗、去势治疗或去势治疗联合化疗）提供了更有利的生存率。同时，在放疗的比较中，近距离放射治疗和调强放疗是两种最佳的治疗方法。此外，在局部治疗的比较中，前列腺根治术的癌症特异性死亡率或全因死亡率相对低于近距离放射治疗或调强放疗，而近距离放射治疗的总生存率相对长于前列腺根治术。
我们的结果表明，局部治疗优于无局部治疗。在三个临床终点（总生存率、癌症特异性死亡率或全因死亡率）的综合比较中，前列腺根治术的癌症特异性死亡率或全因死亡率相对低于放疗，而近距离放射治疗在总生存率方面优于前列腺根治术。
