The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
Prostate. 2022 May;82(7):826-835. doi: 10.1002/pros.24325. Epub 2022 Mar 14.
An updated systematic review and meta-analysis of relevant studies to evaluate the effectiveness of prostate-specific membrane antigen (PSMA)-targeted endoradiotherapy/radioligand therapy (PRLT) in castration resistant prostate cancer (CRPC).
A systematic search was performed in July 2020 using PubMed/Medline database to update our prior systematic review. The search was limited to papers published from 2019 to June 2020. A total of 472 papers were reviewed. The studied parameters included pooled proportion of patients showing any or ≥50% prostate-specific antigen (PSA) decline after PRLT. Survival effects of PRLT were assessed based on pooled hazard ratios (HRs) of the overall survival (OS) according to any PSA as well as ≥50% PSA decline after PRLT. Response to therapy based on ≥50% PSA decrease after PRLT versus controls was evaluated using Mantel-Haenszel random effect meta-analysis. All p values < 0.05 were considered as statistically significant.
A total of 45 publications were added to the prior 24 studies. 69 papers with total of 4157 patients were included for meta-analysis. Meta-analysis of the two recent randomized controlled trials showed that patients treated with Lu-PSMA 617 had a significantly higher response to therapy compared to controls based on ≥50% PSA decrease. Meta-analysis of the HRs of OS according to any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT.
PRLT results in higher proportion of patients responding to therapy based on ≥50% PSA decline compared to controls. Any PSA decline and ≥50% PSA decline showed survival prolongation after PRLT.
This is the first meta-analysis to aggregate the recent randomized controlled trials of PRLT which shows CRPC patients had a higher response to therapy after PRLT compared to controls.
本研究通过更新的系统综述和荟萃分析相关研究，评估前列腺特异性膜抗原（PSMA）靶向内放射治疗/放射性配体治疗（PRLT）在去势抵抗性前列腺癌（CRPC）中的疗效。
我们于 2020 年 7 月在 PubMed/Medline 数据库中进行了系统检索，以更新我们之前的系统综述。检索范围限于 2019 年至 2020 年 6 月发表的论文。共回顾了 472 篇论文。研究参数包括接受 PRLT 后任何或≥50%前列腺特异性抗原（PSA）下降的患者的比例。根据 PRLT 后任何 PSA 以及≥50%PSA 下降后的总生存率（OS）的汇总风险比（HR）评估 PRLT 的生存效果。根据 PRLT 后≥50%PSA 下降与对照组相比的治疗反应，采用 Mantel-Haenszel 随机效应荟萃分析进行评估。所有 p 值<0.05 被认为具有统计学意义。
共有 45 篇文献被纳入到之前的 24 项研究中。纳入 69 篇文献共 4157 例患者进行荟萃分析。最近两项随机对照试验的荟萃分析显示，与对照组相比，接受 Lu-PSMA 617 治疗的患者基于≥50%PSA 下降的治疗反应更高。根据任何 PSA 下降和≥50%PSA 下降的 HRs 进行的 OS 荟萃分析显示，PRLT 后生存时间延长。
与对照组相比，PRLT 使更多患者基于≥50%PSA 下降而对治疗产生反应。任何 PSA 下降和≥50%PSA 下降都表明 PRLT 后生存时间延长。
这是第一项汇总 PRLT 最近随机对照试验的荟萃分析，结果表明与对照组相比，CRPC 患者在接受 PRLT 后对治疗的反应更高。
