Does Hormone Treatment Added to Radiotherapy Improve Outcome in Locally Advanced Prostate Cancer? Meta-Analysis of Randomized Trials
Does Hormone Treatment Added to Radiotherapy Improve Outcome in Locally Advanced Prostate Cancer? Meta-Analysis of Randomized Trials
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DOI：
10.1002/cncr.24392
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发表时间：
2009-08-01
期刊：
影响因子：
6.2
通讯作者：
Carlini, Paolo
中科院分区：
文献类型：
--
作者：
Bria, Emilio;Cuppone, Federica;Carlini, Paolo
背景技术背景：为了量化激素治疗（HT）加单纯放疗治疗局部晚期前列腺癌的获益程度，进行了一项基于文献的荟萃分析。方法：通过随机效应模型得出基于事件的相对风险（RR）及其95%置信区间（CI）。研究了主要结局（生化失败和临床无进展生存期）和次要结局（癌症特异性生存期、总生存期、复发模式和毒性）的差异。计算绝对差异和需要治疗的患者数量（NNT）。还进行了异质性检验、临床结局预测因素的荟萃回归分析和替代终点的相关性分析。结果：收集了7项试验（4387例患者）。激素抑制显著降低了生化失败（RR，0.76; 95%CI，0.70-0.82; P < .0001）和临床无进展生存期（RR，0.81; 95%CI 0.71 -0.93; P = .002），绝对差异分别为10%和7.7%，分别相当于10和13个NNT。癌症特异性存活（RR，0.76; 95% CI，0.69-0.83; P < .0001）和OS（RR，0.86; 95% CI，0.80-0.93; P < .0001）也通过添加HT而显著改善，没有显著异质性，绝对差异分别为5.5%和4.9%，分别为18和20 NNT，HT显著降低了局部和远处复发，分别为36%和28%，并且没有发现毒性的显著差异。结论：激素抑制加放射治疗显著降低局限性前列腺癌患者的复发率和死亡率，而不影响毒性。癌症2009;115：3446-56。(C)2009年美国癌症协会。
BACKGROUND: To quantify the magnitude of benefit of the addition of hormone treatment (HT) to exclusive radiotherapy for locally advanced prostate cancer, a literature-based meta-analysis was conducted. METHODS: Event-based relative risks (RR) with 95% confidence intervals (CIs) were derived through a random-effect model. Differences in primary (biochemical failure and clinical progression-free survival) and secondary outcomes (cancer-specific survival, overall survival COS], recurrence patterns, and toxicity) were explored. Absolute differences and numbers of patients needed to treat (NNT) were calculated. A heterogeneity test, a metaregression analysis with clinical predictors of outcome, and a correlation analysis for surrogate endpoints were also performed. RESULTS: Seven trials (4387 patients) were gathered. Hormone suppression significantly decreased both biochemical failure (RR, 0.76; 95% Cl, 0.70-0.82; P < .0001) and clinical progression-free survival (RR, 0.81; 95% Cl 0,71-0.93; P = .002), with absolute differences of 10% and 7.7%, respectively, which translates into 10 and 13 NNT. cancer-specific survival (RR, 0.76; 95% Cl, 0.69-0.83; P < .0001) and OS (RR, 0.86; 95% Cl, 0.80-0.93; P < .0001) were also significantly improved by the addition of HT, without significant heterogeneity, with absolute differences of 5.5% and 4.9%, respectively, which translates into 18 and 20 NNT Local and distant relapse were significantly decreased by HT, by 36% and 28%, respectively, and no significant differences in toxicity were found. Primary and secondary efficacy outcomes were significantly correlated. CONCLUSIONS: Hormone suppression plus radiotherapy significantly decreases recurrence and mortality of patients with localized prostate cancer, without affecting toxicity. Cancer 2009;115:3446-56. (C) 2009 American Cancer Society.