Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang Province, China.
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Anticancer Agents Med Chem. 2020;20(13):1604-1612. doi: 10.2174/1871520620666200521114815.
Although the adjuvant therapy of bisphosphonates in prostate cancer is effective in improving bone mineral density, it is still uncertain whether bisphosphonates could decrease the risk of Skeletal- Related Event (SRE) in patients with prostate cancer. We reviewed and analyzed the effect of different types of bisphosphonates on the risk of SRE, defined as pathological fracture, spinal cord compression, radiation therapy to the bone, surgery to bone, hypercalcemia, bone pain, or death as a result of prostate cancer.
A systemic literature search was conducted on PubMed and related bibliographies. The emphasis during data extraction was laid on the Hazard Ratio (HR) and the corresponding 95% Confidence Interval (CI) from every eligible Randomized Controlled Trial (RCT). HR was pooled with the fixed effects model, and preplanned subgroup analyses were performed.
5 RCTs (n = 4651) were included and analyzed finally after screening 51 articles. The meta-analysis of all participants showed no significant decrease in the risk of SRE when adding bisphosphonates to control group (HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536) with low heterogeneity (I2 = 0.0% (d.f. = 4) p = 0.679). There was no significant improvement on SRE neither in the subgroups with Metastases (M1) or Castration-Sensitive Prostate Cancer (CSPC) (respectively HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536, I2 = 0.0% (d.f. = 4) p = 0.679; HR = 0.954, 95% CI = 0.837 - 1.088, p = 0.484, I2 = 0.0% (d.f. = 3) p = 0.534).
Our study demonstrated that bisphosphonates could not statistically significantly reduce the risk of SRE in patients with prostate cancer, neither in the subgroups with M1 or CSPC.
尽管在前列腺癌中使用双膦酸盐进行辅助治疗可以有效提高骨密度，但目前仍不确定双膦酸盐是否可以降低前列腺癌患者发生骨骼相关事件（SRE）的风险。我们回顾并分析了不同类型的双膦酸盐对 SRE 风险的影响，SRE 定义为病理性骨折、脊髓压迫、放射性骨治疗、骨手术、高钙血症、骨痛或因前列腺癌导致的死亡。
在 PubMed 和相关文献中进行了系统的文献检索。在数据提取过程中，重点是从每项合格的随机对照试验（RCT）中提取危险比（HR）和相应的 95%置信区间（CI）。HR 采用固定效应模型进行汇总，并进行了预先计划的亚组分析。
经过筛选 51 篇文章后，最终纳入 5 项 RCT（n = 4651）进行分析。所有参与者的荟萃分析显示，在对照组中添加双膦酸盐并不能显著降低 SRE 的风险（HR = 0.968，95%CI = 0.874-1.072，p = 0.536），异质性较低（I2 = 0.0%（df = 4）p = 0.679）。在有转移（M1）或去势敏感型前列腺癌（CSPC）的亚组中，SRE 也没有显著改善（分别为 HR = 0.968，95%CI = 0.874-1.072，p = 0.536，I2 = 0.0%（df = 4）p = 0.679；HR = 0.954，95%CI = 0.837-1.088，p = 0.484，I2 = 0.0%（df = 3）p = 0.534）。
我们的研究表明，双膦酸盐不能在统计学上显著降低前列腺癌患者的 SRE 风险，在 M1 或 CSPC 亚组中也是如此。
