局部治疗对激素敏感性转移性前列腺癌预后影响的Meta分析

Local treatment for the prognosis of hormone-sensitive metastatic prostate cancer： a Meta-analysis

目的 系统评价局部治疗对激素敏感性转移性前列腺癌（mPC）患者预后的影响.方法 检索2001年1月至2016年10月关于激素敏感性mPC患者局部治疗和无局部治疗对比分析的相关文献,检索数据库包括Pubmed、Embase、Cochrane library、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库和万方中文数据库.由2名评价员共同评价纳入研究的质量,并采用Cochrane协作网提供的Revman 5.0统计软件对符合纳入条件的文献进行Meta分析.结果 共纳入5篇文献,其中4篇为回顾性病例对照研究,1篇为前瞻性病例对照研究,共29 354例患者.与无局部治疗组相比,局部治疗组在5年总生存率（OS） （OR =0.18,95％CI0.15～0.22,P＜0.01）、5年疾病特异性生存率（DSS）（OR=0.39,95％ CI0.31～0.49,P＜0.01）和3年OS（OR =0.47,95％CI0.35～0.62,P＜0.01）等方面具有显著优势.亚组分析结果显示,根治性前列腺切除术组的5年OS（OR=0.17,95％CI 0.12 ～0.25,P＜0.01）、5年DSS（OR=0.30,95％CI0.22～0.40,P＜0.01）和3年OS（OR =0.25,95％CI0.19 ～0.32,P ＜0.01）较无局部治疗组有显著优势;外照射放疗组的3年OS较无局部治疗组具有显著优势（0R=0.54,95％CI0.42 ～0.69,P＜0.01）.结论 激素敏感性mPC患者采用根治性前列腺切除术和放疗等局部治疗可能改善预后,需要更多的前瞻性随机对照研究进一步验证.

Objective To evaluate the effect of local treatment for the prognosis of hormonesensitive metastatic prostate cancer.Methods A systematic review of the literature about local treatment for the prognosis of hormone-sensitive metastatic prostate cancer was performed,searching Medline,Embase,Cochrane Library,CBM,CNKI,VIP and Wan Fang database from January 2001 to October 2016.Two authors reviewed the records to identify comparative studies.A meta-analysis was conducted using Review Manager 5.0.Results Five studies were enrolled,including 29 354 patients.Meta-analysis showed that,compared with no local treatment,local treatment had a significant beneficial effect in 5-year overall survival rate （OR =0.18,95 % CI 0.15-0.22,P 〈 0.01）,5-year disease specific survival rate （OR =0.39,95 % CI 0.31-0.49,P〈0.01） as well as 3-year overall survival rate （OR =0.47,95% CI 0.35-0.62,P〈0.01）.Sub-group analysis showed that,compared with no local treatment,prostatectomy had a significant beneficial effect in 5-year overall survival rate （OR =0.17,95 % CI 0.12-0.25,P 〈 0.01）,5-year disease specific survival rate （OR =0.30,95% CI 0.22-0.40,P 〈0.01） as well as 3-year overall survival rate （OR=0.25,95%CI 0.19-0.32,P 〈0.01）,and external beam radiation therapy only had a significant beneficial effect in 3-year overall survival rate （OR =0.54,95% CI 0.42-0.69,P 〈 0.01）.Conclusions Prostatectomy and external beam radiation therapy may have a survival benefit for hormone-sensitive metastatic prostate cancer.Prospective randomized controlled studies are necessary because of the limits of current studies.