Kang Zhen, Li Wei, Yu Yanhong, Yang Junfeng
College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan 650000, China.
Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650000, China.
J Oncol. 2022 Jun 29;2022:7711555. doi: 10.1155/2022/7711555. eCollection 2022.
To compare the effects of different treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC) using a network meta-analysis.
English databases (PubMed, Embase, and medRxiv) and Chinese databases (Wanfang and CNKI) were searched for randomized controlled trials (RCTs) on the treatment of mHSPC from inception to June 1, 2021. The overall survival (OS) and failure-free survival (FFS) reported by the included studies were extracted from each study for network meta-analysis. Moreover, the priority ranks of the treatment methods were determined.
A total of 18 RCTs with 14,682 patients were included in this study. Androgen-deprivation therapy (ADT) + apalutamide (APA) showed the highest probability of improving the OS (96.2%) and FFS (68.0%). In addition, the patients were stratified into ten subgroups as follows: low/high tumor burden (CHAARTED criteria); Gleason score ≤7/≥8; Eastern Cooperative Oncology Group (ECOG) = 0/≥1; with/without prechemotherapy; and cooperative with/without concomitant radiotherapy. For the improvement of OS, the leading treatments were as follows: (1) ADT + enzalutamide (ENZA) (64.1%)/ADT + abiraterone acetate + prednisone (AAP) (54.3%); (2) ADT + ENZA (41.9%)/ADT + APA (39.2%); (3) ADT + ENZA (39.2%)/ADT + APA (32.1%); (4) ADT + radiotherapy (51%)/ADT + ENZA (76.7%); (5) ADT + AAP (51%)/ADT + AAP (60%).
Three endocrine therapy drugs, abiraterone, enzalutamide, and APA, exhibited the best effects in improving the OS and FFS in all patients and subgroups; however, APA had the most prominent treatment effects. Therefore, ADT + APA should be applied as the common treatment for patients with HSPC based on objective and clinical conditions. . This meta-analysis has been registered on the PROSPERO website (Trial number: https://www.crd.york.ac.uk/prospero/CRD42020221062).
采用网状Meta分析比较转移性激素敏感性前列腺癌（mHSPC）不同治疗策略的效果。
检索英文数据库（PubMed、Embase和medRxiv）和中文数据库（万方和知网），查找从数据库建库至2021年6月1日关于mHSPC治疗的随机对照试验（RCT）。从纳入研究中提取报告的总生存期（OS）和无失败生存期（FFS），用于网状Meta分析。此外，确定治疗方法的优先排名。
本研究共纳入18项RCT，涉及14682例患者。雄激素剥夺治疗（ADT）联合阿帕他胺（APA）改善OS（96.2%）和FFS（68.0%）的概率最高。此外，将患者分为以下十个亚组：低/高肿瘤负荷（CHAARTED标准）； Gleason评分≤7/≥8；东部肿瘤协作组（ECOG）=0/≥1；有/无化疗前治疗；以及有/无同步放疗。对于OS的改善，领先的治疗方法如下：（1）ADT联合恩杂鲁胺（ENZA）（64.1%）/ADT联合醋酸阿比特龙+泼尼松（AAP）（54.3%）；（2）ADT联合ENZA（41.9%）/ADT联合APA（39.2%）；（3）ADT联合ENZA（39.2%）/ADT联合APA（32.1%）；（4）ADT联合放疗（51%）/ADT联合ENZA（76.7%）；（5）ADT联合AAP（51%）/ADT联合AAP（60%）。
阿比特龙、恩杂鲁胺和APA这三种内分泌治疗药物在改善所有患者和亚组的OS和FFS方面效果最佳；然而，APA的治疗效果最为显著。因此，应根据客观情况和临床条件，将ADT联合APA作为HSPC患者的常用治疗方法。本Meta分析已在PROSPERO网站注册（试验编号：https://www.crd.york.ac.uk/prospero/CRD42020221062）。
