辅助放疗与挽救性放疗对根治性前列腺切除术后有不良病理特征患者预后影响的比较：系统评价和荟萃分析。
The prognosis benefits of adjuvant versus salvage radiotherapy for patients after radical prostatectomy with adverse pathological features: a systematic review and meta-analysis.
机构信息
Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
出版信息
Radiat Oncol. 2019 Nov 9;14(1):197. doi: 10.1186/s13014-019-1384-z.
BACKGROUND
The appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).
METHODS
PubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3.
RESULTS
A total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (p < 0.0001) and DMFS (p < 0.0001), when compared to SRT. The subgroup analysis of the 5-year OS rate demonstrated that the ART group still had survival advantages compared to the SRT group (p = 0.0006). However, ART and SRT were comparable in 10-year OS rate (p = 0.07). ART had advantages over SRT in both 5-year (p = 0.0003) and 10-year BRFS (p = 0.0003). The subgroup analysis with different follow-up starting points from RP or RT was essentially consistent with the above results. The pooled analysis also showed that ART was superior to ESRT on OS (p = 0.008) and DMFS (p = 0.03), and comparable to ESRT on BRFS (p = 0.1).
CONCLUSIONS
According to this meta-analysis, ART could be served as a preferential treatment for patients with APFs after RP to improve prognosis. Certainly, high-quality, multicenter randomized controlled trials (RCTs) are expecting to confirm the outcomes of our meta-analysis in the future.
背景
对于根治性前列腺切除术（RP）后具有不良病理特征（APFs）的患者，放疗（RT）的适当时机仍存在争议。本系统评价旨在比较辅助放疗（ART）和挽救放疗（SRT）的疗效。
方法
检索 PubMed、EMBASE、Web of Science 和 Cochrane Library 电子数据库，以获取所需文献。提取总生存（OS）、生化无复发生存（BRFS）和远处转移无复发生存（DMFS）的风险比（HR）及其相应的 95%置信区间（CI）。分析 ART 与 SRT（包括早期挽救性放疗（ESRT））的生存获益。使用 RevMan 版本 5.3 进行荟萃分析。
结果
最终共有 15 项回顾性研究纳入最终分析，共 5586 例患者。汇总分析表明，与 SRT 相比，ART 可更好地控制前列腺癌，提高 OS（p=0.0006）、BRFS（p<0.0001）和 DMFS（p<0.0001）。5 年 OS 率的亚组分析表明，ART 组与 SRT 组相比仍具有生存优势（p=0.0006）。然而，ART 和 SRT 在 10 年 OS 率方面无差异（p=0.07）。ART 在 5 年（p=0.0003）和 10 年 BRFS（p=0.0003）方面均优于 SRT。以 RP 或 RT 为起始点的不同随访时间的亚组分析基本与上述结果一致。汇总分析还显示，ART 在 OS（p=0.008）和 DMFS（p=0.03）方面优于 ESRT，在 BRFS 方面与 ESRT 相当（p=0.1）。
结论
根据本荟萃分析，ART 可作为 RP 后具有 APFs 患者的首选治疗方法，以改善预后。当然，未来还需要高质量、多中心的随机对照试验（RCTs）来证实我们荟萃分析的结果。
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