根治性前列腺切除术对淋巴结阳性前列腺癌患者预后影响的系统评价和Meta分析

The benefit of radical prostatectomy in patients with lymph node-positive prostate cancer: a systematic review and Meta-analysis

目的系统评价根治性前列腺切除术(RP)对淋巴结阳性前列腺癌患者预后的影响。方法检索从建库至2018年11月关于淋巴结阳性前列腺癌患者行RP和未行RP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。对纳入的文献使用统计软件RevMan 5.3进行Meta分析。主要结局指标为总生存率(OS)和癌症特异性生存率(CSS)。结果共纳入6篇回顾性研究,包含7 890例患者,其中6 247例行RP治疗,1 643例未行RP治疗。与未行RP者相比,行RP者在OS (HR=0.55,95%CI 0.49~0.62,P<0.001)和CSS (HR=0.49,95%CI 0.42~0.57,P<0.001)方面有显著改善。结论RP可能改善淋巴结阳性前列腺癌患者的OS和CSS,但是需要更多的随机对照试验来验证。

Objective To evaluate the benefit of radical prostatectomy (RP) in patients with lymph node-positive prostate cancer. Methods A systematic review of the studies about radical prostatectomy for the prognosis of node-positive prostate cancer was performed. An electronic search was completed on the basis of PubMed, Embase, Cochrane library, China Biology Medicine disc(CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang database from inception up to November 2018. The outcomes are overall survival (OS) and cancer-specific survival(CSS). Results Six studies incorporating 7 890 patients were eligible for the present meta-analysis. 6 247 patients underwent RP, the remaining 1 643 patients did not undergo RP. Lymph node-positive patients treated with RP had improved OS (HR=0.55, 95%CI 0.49-0.62, P<0.001) and CSS (HR=0.49, 95%CI 0.42-0.57, P<0.001). Conclusions Radical prostatectomy may be a beneficial option for patients with lymph node metastases at initial diagnosis, which also improve the OS and CSS. More randomized controlled trials are needed to give more evidence further.