骨骼肌减少症对前列腺癌治疗预后的影响:Meta分析

Effects of sarcopenia on prognosis of prostate cancer treatment:a Meta-analysis

目的探讨骨骼肌减少症对前列腺癌综合治疗预后的预测作用及价值。方法通过检索Pubmed和Embase数据库截至2023年10月研究前列腺癌和骨骼肌减少症关联性的文献数据,按纳入标准和排除标准进行文献筛选、资料提取和质量评价,利用Stata 9.0软件(Stata Corporation,USA)进行Meta分析,评价骨骼肌减少症发病率及其对前列腺癌总生存期(overall survival,OS)和无进展生存期(progression-free survival,PFS)结局指标的作用。结果共纳入10项研究,共1854例前列腺癌患者。Meta分析结果显示,前列腺癌中骨骼肌减少症的发病率为60%(95%CI:48%~72%);以不同治疗方式进行亚组分析,结果发现采用化疗/内分泌治疗的前列腺癌患者的骨骼肌减少症发病率为48%(95%CI:28%~67%),单纯内分泌组为77%(95%CI:64%~89%),其他组骨骼肌减少症发病率为64%(95%CI:45%~82%);以不同类型前列腺癌进行亚组分析,结果发现去势抵抗性前列腺癌组骨骼肌减少症发病率为64%(95%CI:47%~80%),转移性前列腺癌组为58%(95%CI:37%~79%)。骨骼肌减少症能显著缩短转移性前列腺癌组患者的OS(HR=1.53,95%CI:1.00~2.33)和化疗/内分泌治疗前列腺癌后患者的PFS(HR=2.09,95%CI:1.21~3.61)。结论前列腺癌中骨骼肌减少症的发病率较高,并且骨骼肌减少症能缩短前列腺癌治疗后预后,特别是转移性前列腺癌和同时接受化疗与内分泌治疗的前列腺癌人群,但需要更大样本量的研究进行验证。

Objective To investigate the predictive effects of sarcopenia on the prognosis of prostate cancer after comprehensive treatment and its value.Methods Literature data on the association between prostate cancer and sarcopenia up to October 2023 were retrieved from Pubmed and Embase databases.Literature screening,data extraction and quality evaluation were conducted according to the inclusion and exclusion criteria.Stata 9.0 software(Stata Corporation,USA)was used for the Meta-analysis to evaluate the incidence of sarcopenia and its effect on the overall survival(OS)and progression-free survival(PFS)outcomes of prostate cancer.Results A total of 1,854 prostate cancer patients were included in 10 studies.Meta-analysis showed that the incidence of sarcopenia in prostate cancer was 60%(95%CI:48%-72%).Subgroup analysis with different treatments modalities showed that the incidence of sarcopenia was 48%(95%CI:28%-67%)in prostate cancer patients treated with chemotherapy/endocrine therapy and 77%(95%CI:64%-89%)in the endocrine therapy group,and the incidence of sarcopenia in the other groups was 64%(95%CI:45%-82%).Subgroup analysis of different types of prostate cancer showed that the incidence of sarcopenia was 64%(95%CI:47%-80%)in the castration resistant prostate cancer group and 58%(95%CI:0.37-0.79)in the metastatic prostate cancer group.Sarcopenia significantly shortened the OS(HR=1.53,95%CI:1.00-2.33)in patients with metastatic prostate cancer and PFS(HR=2.09,95%CI:1.21-3.61)in patients with chemotherapy/endocrine therapy for prostate cancer.Conclusions The incidence of sarcopenia is high in prostate cancer,and can shorten the prognosis after prostate cancer treatment,especially for metastatic prostate cancer and the patients receiving chemotherapy and endocrine therapy,though large-size samples are needed for verification.