Wang Zhenghao, Cao DeHong, Wei Wuran
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2021 Apr 22;8:648676. doi: 10.3389/fsurg.2021.648676. eCollection 2021.
A systematic review and meta-analysis was conducted to explore the effect of local treatment (LT) on overall survival (OS) and cancer-specific mortality (CSM) for patients diagnosed with M1c prostate cancer (PCa). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of LT on patients with M1c Pca. The search strategy and study selection process was managed according to the PRISMA statement. Four cohort respective studies were identified for satisfying the inclusion criteria. Our results indicated that LT significantly improved CSM ( = 0.36, 95% = 0.22-0.60; < 0.0001) and OS ( = 0.42, 95% = 0.24-0.77; = 0.004). Subgroup analysis showed that radical prostatectomy (RP) and radiation therapy (RT) including brachytherapy (BT), conformal radiation therapy (CRT), and intensity modulated radiation (IMRT) had a significant benefit on cutting down the CSM of M1c PCa patients ( = 0.27, 95% = 0.13-0.56; = 0.0005 and = 0.42, 95% = 0.20-0.89; = 0.02). In addition, RP had improved the OS for patients ( = 0.33, 95% = 0.15-0.73; = 0.008). There was no difference of OS in patients that underwent RT ( = 0.58, 95% = 0.24-1.40; = 0.23). No significant heterogeneity was among the results, indicating consistency in the study. Present meta-analysis indicates that LT for M1c PCa correlated with decreased CSM and enhanced OS. The survival benefit of RP was successfully confirmed and the advantage of RT seemed to be associated with the tumor burden and method of RT.
进行了一项系统评价和荟萃分析，以探讨局部治疗（LT）对诊断为M1c期前列腺癌（PCa）患者的总生存期（OS）和癌症特异性死亡率（CSM）的影响。在PubMed、科学网、Embase、EBSCO和Cochrane图书馆数据库（2020年11月更新）中检索评估LT对M1c期PCa患者影响的研究。检索策略和研究选择过程按照PRISMA声明进行管理。确定了四项队列研究符合纳入标准。我们的结果表明，LT显著改善了CSM（HR = 0.36，95%CI = 0.22 - 0.60；P < 0.0001）和OS（HR = 0.42，95%CI = 0.24 - 0.77；P = 0.004）。亚组分析表明，根治性前列腺切除术（RP）和包括近距离放疗（BT）、适形放疗（CRT）和调强放疗（IMRT）在内的放射治疗（RT）对降低M1c期PCa患者的CSM有显著益处（HR = 0.27，95%CI = 0.13 - 0.56；P = 0.0005和HR = 0.42，95%CI = 0.20 - 0.89；P = 0.02）。此外，RP改善了患者的OS（HR = 0.33，95%CI = 0.15 - 0.73；P = 0.008）。接受RT的患者OS没有差异（HR = 0.58，95%CI = 0.24 - 1.40；P = 0.23）。结果之间无显著异质性，表明研究具有一致性。目前的荟萃分析表明，M1c期PCa的LT与CSM降低和OS提高相关。RP的生存益处得到成功证实，RT的优势似乎与肿瘤负荷和RT方法有关。
