双膦酸盐类药物对前列腺癌生存及骨转移影响的Meta分析

Meta-analysis of the effect of bisphosphonates on survival and bone metastases in prostate cancer

目的:分析双膦酸盐类药物对前列腺癌患者总生存期(OS)及骨转移的影响,为探讨双膦酸盐类药物改善前列腺癌预后提供依据。方法:采用计算机并配合手工检索中国知网、万方数据库、维普数据库、Web of Science、PubMed、Embase及Cochrane Library,搜索截止时间为2024年1月,检索文章为公开发表的关于双膦酸盐类药物辅助治疗前列腺癌的所有随机对照试验。主要观察指标包括患者OS、风险比(HR)及其95%置信区间(95%CI),次要指标为骨转移引起的骨痛和骨相关事件(SREs)等不良事件的发生率。使用Revman、Stata软件进行Meta分析。结果:共纳入10项随机对照试验。Meta分析结果显示,双膦酸盐辅助治疗组和安慰剂组之间的OS结果为阴性(HR=-0.07,95%CI:-0.21~0.07,P=0.331);SREs发生率无明显改变(OR=0.88,95%CI:0.69~1.13,Z=-0.993,P>0.05),差异均无统计学意义。结论:双膦酸盐类药物无法延缓前列腺癌患者的病情进展和延长生存期,也无法降低骨转移所致SREs等不良事件的发生率。

Objective:To analyze the effect of bisphosphonates on the overall survival(OS)of prostate cancer patients,and to provide a theoretical basis for improving the prognosis of prostate cancer with bisphosphonates.Methods:A computerized and manual search of the China Knowledge Network database,Wanfang database,VIP database,Web of Science,PubMed,Embase,and Cochrane Library was used with a search deadline of January 2024,and articles were searched for all published randomized controlled trials on the adjuvant treatment of prostate cancer with bisphosphonates.The primary observables included patient OS,Hazard atio(HR)and its 95%confidence interval(95%CI),and the secondary observables were the incidence of adverse events such as bone pain and skeletal related events(SREs)due to bone metastases.Meta-analysis was performed using the Revman and Stata software.Results:A total of 10 randomized controlled trials were included.Meta-analysis showed that the OS results between the bisphosphonate-adjuvant therapy group and the placebo group were negative(HR=-0.07,95%CI:-0.21 to 0.07,P=0.331);there was no significant change in the incidence of SREs(OR=0.88,95%CI:0.69 to 1.13,Z=-0.993,P>0.05).The differences were not statistically significant.Conclusion:Bisphosphonates can not slow the disease progression and prolong the survival in prostate cancer patients,nor can they reduce the incidence of adverse events such as SREs due to bone metastases.