5-α还原酶抑制剂在前列腺癌化学预防中对死亡率的影响：一项荟萃分析。

The impact of 5-alpha-reductase inhibitors on mortality in a prostate cancer chemoprevention setting: a meta-analysis.

作者信息

Knijnik Pedro Glusman, Brum Pietro Waltrick, Cachoeira Eduardo Tosetto, Paludo Artur de Oliveira, Gorgen Antônio Rebello Horta, Burttet Lucas Medeiros, Neyeloff Jeruza Lavanholi, Neto Brasil Silva

机构信息

Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Urology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

出版信息

World J Urol. 2021 Feb;39(2):365-376. doi: 10.1007/s00345-020-03202-2. Epub 2020 Apr 20.

DOI:10.1007/s00345-020-03202-2

PMID:32314009

Abstract

PURPOSE

This study aims to evaluate the impact of 5-alpha-reductase inhibitors (5ARI) for prostate cancer (PCa) primary prevention on specific and overall mortality (primary outcomes), the incidence of PCa diagnosis and disease aggressiveness (secondary outcomes).

METHODS

We searched MEDLINE, EMBASE, Cochrane, ClinicalTrials and BVS through April 2018 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement to identify randomized clinical trials (RCT) and cohort studies (CS). We included articles with data on mortality or PCa incidence for men using 5ARI previously to PCa diagnosis.

RESULTS

Regarding the included studies, nine had data on mortality, 16 on PCa incidence and 12 on Gleason scores (GS). We found that the use of 5ARI had no impact on overall mortality (RR 0.93 95% CI 0.78-1.11) and PCa-related mortality (RR 1.35 95% CI 0.50-3.94), nor on high-grade PCa diagnosis (RR 1.06 95% CI 0.72-1.56). We identified a relative risk reduction of 24% in moderate-grade PCa diagnosis (RR 0.76 95% CI 0.59-0.98) and low-grade PCa diagnosis (RR 0.76 95% CI 0.59-0.97) Also, a reduction of 26% in overall PCa diagnosis was observed in the RCT subgroup analysis (RR 0.74 95% CI 0.65-0.84).

CONCLUSION

5ARI significantly reduced the risk of being diagnosed with PCa, not increasing high-grade disease, overall or cancer-specific mortality. Due to the relatively short mean follow-up of most studies, the mortality analysis is limited.

摘要

目的

本研究旨在评估5α-还原酶抑制剂（5ARI）用于前列腺癌（PCa）一级预防对特定死亡率和总死亡率（主要结局）、PCa诊断发病率及疾病侵袭性（次要结局）的影响。

方法

我们根据系统评价和Meta分析的首选报告项目（PRISMA）声明，检索了截至2018年4月的MEDLINE、EMBASE、Cochrane、ClinicalTrials和BVS，以识别随机临床试验（RCT）和队列研究（CS）。我们纳入了在PCa诊断前使用5ARI的男性的死亡率或PCa发病率数据的文章。

结果

关于纳入的研究，9项有死亡率数据，16项有PCa发病率数据，12项有 Gleason评分（GS）数据。我们发现，使用5ARI对总死亡率（RR 0.93，95%CI 0.78-1.11）和PCa相关死亡率（RR 1.35，95%CI 0.50-3.94）没有影响，对高级别PCa诊断（RR 1.06，95%CI 0.72-1.56）也没有影响。我们发现中度PCa诊断的相对风险降低了24%（RR 0.76，95%CI 0.59-0.98），低级别PCa诊断的相对风险降低了24%（RR 0.76，95%CI 0.59-0.97）。此外，在RCT亚组分析中，PCa总体诊断率降低了26%（RR 0.74，95%CI 0.65-0.84）。