前列腺癌近距离照射联合外照射与单纯外照射疗效与安全性Meta分析

Efficacy and safety between brachytherapy combined with external beam radiation therapy and external beam radiation therapy alone for prostate cancer: a meta-analysis

目的系统评价近距离照射(BT)联合外照射(EBRT)与单纯EBRT对前列腺癌的疗效和安全性。方法通过计算机检索Pubmed、Web of science、Cochrane Library、CNKI、万方和维普数据库中EBRT联合BT与单纯EBRT治疗前列腺癌的比较实验,检索时间均从建库至2018年7月,按照纳入和排除标准对纳入研究进行资料提取、方法学质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入10项研究(含6篇RCT,4篇非RCT),共23393例患者。中危3、5年无生化进展生存率(b-PFS)OR值分别为2.03(95%CI为1.11~3.73,P=0.02)、2.27(95%CI为1.49~3.45,P<0.01),EBRT+BT组优于EBRT组;高危3、5年b-PFS、5年总生存率和5年无转移生存率两组相近。泌尿生殖道≥2、≥3级急性和慢性不良反应OR值分别为1.44(95%CI为1.1~1.38,P<0.01)、3.06(95%CI为1.37~6.80,P<0.01)和1.75(95%CI为1.14~2.69,P=0.01)、3.41(95%CI为2.42~4.82,P<0.01),EBRT组均优于EBRT+BT组;胃肠道不良反应两组相近。结论BT联合EBRT较单纯EBRT能改善中危前列腺癌患者3、5年b-PFS,但同时也增加了泌尿生殖道不良反应发生率。

Objective To systematically evaluate the efficacy and safety of brachytherapy (BT) combined with external beam radiation therapy (EBRT) and EBRT alone for prostate cancer. Methods Databases including PubMed, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP were searched from the inception to July 2018 to collect the clinical trials which comparatively analyzed the efficacy and safety between EBRT plus BT and EBRT alone for prostate cancer. According to the inclusion and exclusion criteria, data of the included studies were extracted and the methodological quality was evaluated. Then, a meta-analysis was performed using RevMan 5.3. Results Ten studies of 23 393 patients were included, in which 6 were randomized controlled trials (RCTs) and the other 4 were non-RCTs.The 3-year biochemical progression-free survival (b-PFS)[OR=2.03(95%CI: 1.11 to 3.73), P=0.02]and the 5-year b-PFS of intermediate-risk patients[OR=2.27(95%CI: 1.49 to 3.45), P<0.01] in the EBRT+ BT group were significantly higher compared with those in the EBRT group. The 3-and 5-year b-PFS, 5-year overall survival and 5-year metastasis-free survival did not differ between two groups. in the incidence of ≥grade 2 acute[OR=1.44(95%CI: 1.11 to 1.38), P<0.01] and chronic genitourinary adverse reactions[OR=3.06(95%CI: 1.37 to 6.80), P<0.01],≥grade 3 acute[OR=1.75(95%CI: 1.14 to 2.69), P=0.01] and chronic genitourinary adverse reactions[OR=3.41(95%CI: 2.42 to 4.82), P<0.01] in the EBRT group were significantly lower than those in the EBRT+ BT group. The incidence of gastrointestinal adverse reactions did not significantly differ between two groups. Conclusion Compared with EBRT alone, EBRT combined with BT can effectively improve the 3-and 5-year b-PFS, whereas increase the incidence of genitourinary adverse reactions for patients with intermediate-risk prostate cancer.