三种不同治疗方法对前列腺癌患者疗效对比的meta分析

Comparison of curative effect of three different treatment methods on patients with prostate cancer:a meta-analysis

目的利用meta分析方法对局限性前列腺癌患者根治术(Radical Prostatectomy,RP)、放射治疗(Radio Therapy,RT)和主动监控(Active Surveilance,AS)疗效进行对比。方法计算机检索PubMed、Embase、Cochrane databases、中国知网、万方数据库、维普数据库,查找并筛选RP、RT和AS与前列腺癌疗效有关的研究。两人进行文献筛选,质量评价及数据提取,采用ReviewManager5.4和R4.0.5软件进行meta分析及其他统计学分析。结果共纳入14篇文献,累计研究对象60971例,RP组32749例,RT组22188例,AS组6034例。meta分析显示,RP的死亡率低于RT和AS,差异均有统计学意义(P<0.05);RP和RT在复发率上无差别;RP的性功能障碍发病危险高于RT和AS,RT的性功能障碍发病危险高于AS,差异均有统计学意义(P<0.05);RP的泌尿功能障碍发病危险高于RT和AS,差异均有统计学意义(P<0.05);RP的肠功能紊乱发病危险低于RT,差异有统计学意义(P<0.05)。结论三种方法在死亡率和并发症发病危险上有差异,手术治疗后死亡率和肠功能障碍的发病危险低于其他治疗方法,放疗后性功能障碍和泌尿功能障碍的发病危险低于其他治疗方法,主动监控死亡率较高,但各种并发症的发病危险都较低。故选择治疗方法时,告知患者各种治疗方法的死亡风险和发生并发症的危险,结合患者情况和患者意愿选择合适的治疗方法。

Objective To compare with efficacy of Radical Prostatectomy(RP),Radiotherapy(RT)and Avtive Surveillance(AS)in patients with localized prostate cancer via meta-analysis.Methods Chinese databases,such as CNKI,Wanfang Data VIP,and English databases,such as PubMed,Embase and Cochrane databases were searched for the observational studies on relevance RP,RT and AS with curative effect.Two members conducted literature screening,quality evaluation and data extraction,then Review Manager 5.4 and R4.0.5 software were used in meta-Analysis.Results A total of 14 documents were included,with a total of 60971 objects,32749 in RP group,22188 in RT group and 6034 in AS group.Meta analysis showd that mortality of RP was lower than RT and AS(P<0.05);There was no difference between RP and RT in recurrence rate;The risk of sexual dysfunction of RP was higher than that of RT and AS;The risk of urinary dysfunction in RP was higher than that in RT and AS(P<0.05),and the risk of intestinal dysfunction in RP was lower than that in RT(P<0.05).Conclusion The three methods had differences in mortality and risk of complications.The mortality and risk of intestinal dysfunction after surgery were lower than those of other methods.The risk of sexual dysfunction and urinary dysfunction after radiotherapy was lower than that of other methods.The active monitoring mortality was higher,but the risk of various complications was lower.Therefore,when choosing treatment methods,informing the patient of the risk of death and complications of various treatment methods,and choosing the appropriate treatment methods according to the conditions and wishes of the patient.