Ying Wenwei, Ding Zhenshan, He Yuhui, Wang Jianfeng, Chen Xing, Li Xuesong, Gong Yanqing
Department of Urology, Peking University First Hospital, Beijing, China.
Institution of Urology, Peking University, Beijing, China.
PeerJ. 2025 Aug 29;13:e19819. doi: 10.7717/peerj.19819. eCollection 2025.
In recent years, the treatment approach for metastatic prostate cancer has evolved, with early combination therapies increasingly being favored over androgen-deprivation therapy (ADT) alone. Despite the availability of various treatments, their relative effectiveness and safety trade-offs remain uncertain. Randomized controlled trials have explored a range of treatments for oligometastatic prostate cancer, but clear conclusions regarding their prognostic benefits and patient-centered outcomes have not been established. This network meta-analysis (NMA) aims to quantify the benefits of different treatments by analyzing data from a systematic search of Medline, EMBASE, and Cochrane databases, covering trials up to October 1, 2024. The primary outcomes evaluated in this study include overall survival (OS), progression-free survival (PFS), treatment-related adverse events (TRAEs), and quality of life (QoL). This study is registered with PROSPERO (CRD42022370203). We analyzed individual patient data from 13 eligible trials, involving a total of 2,524 patients. Our analysis revealed that ADT+ radiation therapy (RT) (hazard ratio (HR) = 0.39, 95% confidence interval (CI) [0.27-0.56]) and ADT+stereotactic body radiotherapy (SBRT) (HR = 0.35, 95% CI [0.21-0.58]) significantly improved progression-free survival (PFS) compared to ADT alone, while no treatment showed a significant overall survival (OS) benefit. Safety analysis revealed ADT monotherapy had the lowest risk of grade ≥3 adverse events (TRAEs), whereas ADT+abiraterone increased toxicity (OR = 1.54). Limited quality of life (QoL) data suggested ADT+RT may offer slight improvement (surface under the cumulative ranking curve (SUCRA) 74.3%). Most trials exhibited low bias risk, though heterogeneity and small sample sizes for some comparisons warrant cautious interpretation. These findings support ADT+RT/SBRT for PFS benefit but highlight the need for further research to optimize survival outcomes and treatment tolerability.
近年来，转移性前列腺癌的治疗方法不断演变，早期联合疗法越来越受到青睐，而不再仅仅采用雄激素剥夺疗法（ADT）。尽管有多种治疗方法可供选择，但其相对有效性和安全性的权衡仍不明确。随机对照试验探索了一系列治疗寡转移性前列腺癌的方法，但关于其预后益处和以患者为中心的结果尚未得出明确结论。这项网络荟萃分析（NMA）旨在通过分析对Medline、EMBASE和Cochrane数据库进行系统检索得到的数据，量化不同治疗方法的益处，涵盖截至2024年10月1日的试验。本研究评估的主要结局包括总生存期（OS）、无进展生存期（PFS）、治疗相关不良事件（TRAEs）和生活质量（QoL）。本研究已在国际前瞻性注册系统（PROSPERO）注册（CRD42022370203）。我们分析了来自13项符合条件的试验的个体患者数据，共涉及2524名患者。我们的分析表明，与单纯ADT相比，ADT+放射治疗（RT）（风险比（HR）=0.39，95%置信区间（CI）[0.27 - 0.56]）和ADT+立体定向体部放疗（SBRT）（HR = 0.35，95% CI [0.21 - 0.58]）显著改善了无进展生存期（PFS），而没有一种治疗方法显示出显著的总生存期（OS）益处。安全性分析显示，ADT单药治疗发生≥3级不良事件（TRAEs）的风险最低，而ADT+阿比特龙增加了毒性（比值比（OR）=1.54）。有限的生活质量（QoL）数据表明，ADT+RT可能会带来轻微改善（累积排序曲线下面积（SUCRA）为74.3%）。大多数试验显示偏倚风险较低，不过某些比较存在异质性且样本量较小，需要谨慎解读。这些发现支持ADT+RT/SBRT对PFS的益处，但强调需要进一步研究以优化生存结局和治疗耐受性。
