外周血中AR-V7 mRNA与前列腺癌患者预后关系的Meta分析

Prognostic value of AR-V7 mRNA in peripheral blood of man with prostate cancer-a Meta analysis

目的 系统评价外周血雄激素受体剪接变异体7(AR-V7)检测在预测去势抵抗性前列腺癌患者预后中的作用。方法 计算机检索PubMed、EMBASE、Cochrane library、中国期刊全文数据库(CNKI),检索时间均从建库至2018年5月,纳入探究外周血AR-V7检测与激素抵抗性前列腺癌预后关系的临床研究。根据纽卡斯尔-渥太华(NOS)量表对纳入文献进行质量评价,采用RevMan5.3软件进行Meta分析,研究结局为无进展生存期(PFS)和总生存期(OS)。结果 最终纳入英文文献6篇,共计483例患者。固定效应模型显示:AR-V7阳性患者较AR-V7阴性患者预后差。临床或影像PFS:[ HR =3.28,95% CI (2.38,4.51), P < 0.000 1 ],OS:[ HR =2.68,95% CI (1.89,3.80), P < 0.000 1 ]。根据治疗药物不同对OS进行亚组分析,结果显示:紫杉醇类化疗药物[ HR =1.35,95% CI (0.56,3.25), P =0.50],激素类药物:[ HR =3.05,95% CI ( 2.09 , 4.47 ), P < 0.000 1 ],提示对于ARV7阳性患者,紫杉醇类化疗药物较激素类药物可降低风险比。结论 外周血AR-V7阳性前列腺癌患者与AR-V7阴性者相比预后较差,血中检测AR-V7可作为前列腺癌患者预后预测指标,并可对前列腺癌的治疗方案选择提供指导意义。

Objective To evaluate the value of detecting androgen receptor splice Variant 7(AR-V7)mRNA in blood of patients with castration-resistant prostate cancer(CRPC)by conducting a Meta-analysis. Methods We searched literature published before May 2018,Using the PubMed,Cochran library,EMBASE and CNKI database,studies assessing the prognostic relevance of ARV7 detection in peripheral blood of prostate cancer were selected for this analysis.Quality Of included studies was assessed by newcastle-ottawa scale (NOS).Review manager 5.3 was used for meta-analysis and the main parameters included progress-free survival(PFS)and overall survival(OS). Results Our analysis consisted of 6 studies,enrolling a total of 483 patients.Fixed effect show that ARV7-positive patients was significantly poor.PFS:[ HR =3.28,95% CI (2.38,4.51), P < 0.000 1 ],OS:[ HR =2.68,95% CI (1.89,3.80), P <0.000 1],which compared with the ARV7-negative patients.The subgroup analysis by the different therapies showed that clinical outcome were superior with Taxane chemotherapy[ HR =1.35,95% CI (0.56,3.25), P =0.50] compared with novel hormonal therapies (NHT)[ HR = 3.05 ,95% CI (2.09,4.47), P <0.000 1] in ARV7-positive men. Conclusion This meta-analysis indicates that the presence of AR-V7 in patients with CRPC has a poor prognosis compared with the patients ARV7-negative.Detection of AR-V7 might be served as a prognosticator and a treatment selection biomarker in CRPC.