临床局限性前列腺癌根治性切除与观察等待预后比较的Meta分析

Radical prostatectomy versus watchful waiting for clinically localized prostate cancer:A Meta-Analysis

目的：比较临床局限性前列腺癌行根治性切除（radical prostatectomy, RP）和观察等待（watchful waiting, WW）对患者生存的影响。方法通过计算机检索Medline、Cochrane Library、ISI web of knowledge、SinoMed文献检索平台，搜集国内外2014年7月前发表的关于早期前列腺癌根治性切除与主动监测的预后的随机、半随机对照试验或观察性研究，预后评价指标包括总体死亡、前列腺癌特异死亡；由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan5.2进行统计分析。结果纳入3个随机对照试验和10个临床队列研究，其中RCT共1537例、队列研究共186590例患者；Meta分析结果显示两种治疗方法（RP/WW）的总体死亡（ACM）风险为HR=0.59[95%CI（0.51，0.69），P＜0.00001]，前列腺癌特异死亡（CSM）风险HR=0.43[95%CI（0.32，0.58），P＜0.00001]，且不论RCT组还是队列研究组，结果均一致倾向RP。结论早期前列腺癌根治性切除可减少总体死亡及前列腺癌特异死亡风险，对于早期局限性前列腺癌选择观察等待应当十分慎重。

Objective To compare the survival effect of clinically localized prostate cancer treated by radical prostatectomy （RP） and watchful waiting （WW） . Methods Randomized controlled trials or observational studies were searched from database of Medline, Cochrane Library, ISI web of knowledge and SinoMed for the evaluation of prognosis of clinically localized prostate cancer treated by RP versus WW. Prognosis evaluation parameter included all-cause mortality and prostate cancer specific mortality. The latest retrieval date was July 2014. The data extraction and the quality assessment of included studies were independently conducted by 2 reviewers. RevMan5.2 software was used to perform data synthesis. Results 3 RCTs involving 1 537 patients （772 RP versus 765 WW） and 10 retrospective cohort studies involving 186 590 patients （104441 RP versus 82149 WW） were enrolled finally. The results of meta-analysis showed that both the hazard of all-cause mortality and prostate cancer specific mortality in RP group were significantly lower than that of WW group, all-cause mortality risk was HR=0.59 [95%CI （0.51, 0.69）,P〈0.00001], and prostate cancer specific mortality risk was HR=0.43 [95%CI （0.32, 0.58）, P〈0.00001]. All outcomes favored radical prostatectomy regardless of study type stratification. Conclusion Radical prostatectomy reduces the hazard of all-cause mortality and cancer specific mortality of clinically localized prostate cancer, which may push more deliberations when physicians take watchful waiting in consideration.