Cheng Bisheng, Li Bingheng, Fu Jianhan, Wang Qiong, Luo Tianlong, Li Zean, Peng Shirong, Wu Jilin, Zhou Qianghua, Wu Peng, Huang Hai
Sun Yat-sen Memorial Hospital, Sun Yat-sen University.
Department of Urology, Nanfang Hospital, Southern Medical University.
Int J Surg. 2025 Jan 1;111(1):122-134. doi: 10.1097/JS9.0000000000001968.
Oligometastatic prostate cancer (OmPCa) is characterized by a restricted number of metastatic lesions confined to a limited organ range, presenting a distinct clinical challenge. The role of cytoreductive prostatectomy (CRP) in managing this specific metastatic stage has gained attention but remains controversial. This study aims to assess the effectiveness of CRP in OmPCa by synthesizing outcomes from previous studies and analyzing data from a multicenter, retrospective cohort.
We focused on evaluating overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), and castration-resistant prostate cancer-free survival (CRPCFS) as primary outcomes. A multicenter comparative retrospective analysis was also conducted on OmPCa patients treated with CRP versus those receiving androgen deprivation therapy (ADT) alone from January 2008 to June 2018. We gathered and analyzed data on patient demographics, tumor characteristics, surgical outcomes, and survival metrics.
The quantitative analysis included 18 studies [2 randomized controlled trials (RCTs) and 16 non-RCT studies], comprising a total of 1733 patients with OmPCa, and this is the largest number of samples included in the same subject research at present. The pooled analysis demonstrated that cytoreductive surgery was associated with significantly improved OS [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.40-0.60], PFS (HR 0.39, 95% CI 0.27-0.51), CSS (HR 0.44, 95% CI 0.23-0.65), and CRPCFS (HR 0.48, 95% CI 0.36-0.59) compared to nonsurgical management. In addition, OS, PFS, and CRPCFS showed better results in the CRP group in all analyses (RCTs and non-RCTs). Additionally, in our multicenter retrospective research analysis, 64 patients with OmPCa were included, 32 underwent CRP (50%) and 32 underwent ADT alone (50%). The median follow-up time was 40.1 (18.9-51.3) months. The OS ( P =0.0182), PFS ( P =0.0297), and CRPCFS ( P =0.0125) had statistical differences between the two matched cohorts. Moreover, we observed 8 (25%) cases of perioperative complications, with the most common being urinary incontinence (9.4%).
Incorporating CRP alongside ADT in the treatment protocol for OmPCa significantly enhances patient outcomes in terms of OS, PFS, and CRPC-free survival, underscoring the potential benefit of this surgical approach in the specified patient population.
寡转移性前列腺癌（OmPCa）的特征是转移病灶数量有限，局限于有限的器官范围，这带来了独特的临床挑战。减瘤性前列腺切除术（CRP）在管理这一特定转移阶段中的作用已受到关注，但仍存在争议。本研究旨在通过综合既往研究结果并分析来自多中心回顾性队列的数据，评估CRP在OmPCa中的有效性。
我们重点评估总生存期（OS）、无进展生存期（PFS）、癌症特异性生存期（CSS）和去势抵抗性前列腺癌无进展生存期（CRPCFS）作为主要结局。还对2008年1月至2018年6月接受CRP治疗的OmPCa患者与仅接受雄激素剥夺治疗（ADT）的患者进行了多中心比较回顾性分析。我们收集并分析了患者人口统计学、肿瘤特征、手术结局和生存指标的数据。
定量分析纳入了18项研究[2项随机对照试验（RCT）和16项非RCT研究]，共1733例OmPCa患者，这是目前同一主题研究中纳入样本量最大的。汇总分析表明，与非手术治疗相比，减瘤手术与显著改善的OS[风险比（HR）0.50，95%置信区间（CI）0.40 - 0.60]、PFS（HR 0.39，95%CI 0.27 - 0.51）、CSS（HR 0.44，95%CI 0.23 - 0.65）和CRPCFS（HR 0.48，95%CI 0.36 - 0.59）相关。此外，在所有分析（RCT和非RCT）中，CRP组的OS、PFS和CRPCFS均显示出更好的结果。此外，在我们的多中心回顾性研究分析中，纳入了64例OmPCa患者，32例行CRP（50%），32例仅行ADT（50%）。中位随访时间为40.1（18.9 - 51.3）个月。两个匹配队列之间的OS（P = 0.0182）、PFS（P = 0.0297）和CRPCFS（P = 0.0125）存在统计学差异。此外，我们观察到8例（25%）围手术期并发症，最常见的是尿失禁（9.4%）。
在OmPCa的治疗方案中，将CRP与ADT联合使用可显著提高患者在OS、PFS和无CRPC生存期方面的结局，强调了这种手术方法在特定患者群体中的潜在益处。
