Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
Asian J Androl. 2021 Jul-Aug;23(4):429-436. doi: 10.4103/aja.aja_96_20.
This study aimed to identify the pathological outcomes and survival benefits of neoadjuvant hormone therapy (NHT) combined with radical prostatectomy (RP) and radiotherapy (RT) administered to patients with high-risk prostate cancer (HRPCa). We searched PubMed, Embase, and the Cochrane Library for studies comparing NHT plus RP or RT with RP or RT alone, administered to patients with HRPCa. We used a random-effects model to compute risk estimates with 95% confidence intervals (CIs) and quantified heterogeneity using the I "2" statistic. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. We selected 16 studies. NHT before RP significantly decreased lymph node involvement (risk ratio [RR] = 0.69, 95% CI: 0.56-0.87) and increased the rates of pathological downstaging (RR = 2.62, 95% CI: 1.22-5.61) and organ-confinement (RR = 2.24, 95% CI: 1.54-3.25), but did not improve overall survival and biochemical progression-free survival (bPFS). The administration of NHT before RT to patients with HRPCa was associated with significant benefits for cancer-specific survival (hazard ratio [HR] = 0.51, 95% CI: 0.39-0.68), disease-free survival (HR = 0.51, 95% CI: 0.44-0.60), and bPFS (HR = 0.54, 95% CI: 0.46-0.64). Short-term NHT combined with RT administered to patients with HRPCa conferred significant improvements. Although the advantage of local control was observed when NHT was administered before RP, there was no significant survival benefit associated with HRPCa. Therefore, short-term NHT combined with RT is recommended for implementation in standard clinical practice but not for patients who undergo RP.
本研究旨在确定新辅助激素治疗（NHT）联合根治性前列腺切除术（RP）和放疗（RT）与单独 RP 或 RT 治疗高危前列腺癌（HRPCa）患者的病理结局和生存获益。我们检索了 PubMed、Embase 和 Cochrane 图书馆，以寻找比较 NHT 联合 RP 或 RT 与单独 RP 或 RT 治疗 HRPCa 患者的研究。我们使用随机效应模型计算风险估计值，并使用 I²统计量量化异质性。进行亚组和敏感性分析以确定潜在的异质性来源。我们选择了 16 项研究。NHT 联合 RP 可显著降低淋巴结受累风险（风险比 [RR] = 0.69，95%置信区间 [CI]：0.56-0.87），并提高病理降期率（RR = 2.62，95% CI：1.22-5.61）和器官局限率（RR = 2.24，95% CI：1.54-3.25），但不能提高总生存和生化无进展生存期（bPFS）。NHT 联合 RT 治疗 HRPCa 患者与癌症特异性生存（风险比 [HR] = 0.51，95% CI：0.39-0.68）、无病生存（HR = 0.51，95% CI：0.44-0.60）和 bPFS（HR = 0.54，95% CI：0.46-0.64）显著获益相关。短期 NHT 联合 RT 治疗 HRPCa 患者可显著改善预后。尽管在 RP 前给予 NHT 可提高局部控制率，但与 HRPCa 相关的生存获益并不显著。因此，推荐在标准临床实践中实施短期 NHT 联合 RT，但不推荐用于接受 RP 的患者。
