A structured literature review of treatment for localized prostate cancer. Prostate Disease Patient Outcome Research Team.
A structured literature review of treatment for localized prostate cancer. Prostate Disease Patient Outcome Research Team.
复制标题
局限性前列腺癌治疗的结构化文献综述。
DOI：
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发表时间：
1993
期刊：
影响因子：
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通讯作者：
J. Wennberg
中科院分区：
文献类型：
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作者：
John H. Wasson;Cushman Cc;Bruskewitz Rc;Benjamin Littenberg;Mulley Ag;J. Wennberg
目的
我们进行了结构化的文献综述，以确定局限性前列腺癌的临床过程，根治性手术和放射治疗的有效性，以及治疗并发症。
文章精选
我们确定了1966年至1991年的1600多篇英文MEDLINE参考文献。除144例外，其余均被排除，因为他们缺乏原始数据，涉及的患者少于15例，或者既没有描述疾病的过程，也没有描述治疗并发症。
资料综合
在这144篇文章中，根治性手术后持续性泌尿生殖系统并发症比外照射后更常见。辐射导致了更高的肠道问题发生率。发生远处转移和癌症相关死亡的中位年风险分别为2.6%和1.0%。因为肿瘤分级与转移（斯皮尔曼相关系数r = 0.56）和癌症死亡率（r = 0.31）相关，所以在我们比较治疗对这些结果的有效性之前，控制分级是必要的。然而，在描述转移率的患者系列中，只有9例患者和7例患者描述了癌症相关死亡率。此外，在描述前列腺癌相关转移率的患者系列中，48%忽略了识别无法随访的患者，92%未按年龄对患者进行分层，只有48%按治疗时的疾病程度对患者进行分层。
结论
虽然我们能够比较治疗的并发症，但由于我们回顾的文献中的方法学不足，我们无法确定局限性前列腺癌的治疗效果。在获得更好的科学证据之前，患者和他们的医生无法根据根治性乳房切除术，放射治疗或观察等待的好处的知识做出明智的选择。
OBJECTIVE
We performed a structured literature review to define the clinical course of localized prostate cancer, the effectiveness of radical surgery and radiation therapy, and treatment complications.
ARTICLE SELECTION
We identified more than 1600 English-language, MEDLINE referenced articles for 1966 through 1991. All but 144 were excluded because they lacked primary data, involved fewer than 15 patients, or described neither the course of the disease nor treatment complications.
DATA SYNTHESIS
In these 144 articles, persistent genitourinary complications were more common after radical surgery than after external-beam radiation. Radiation resulted in a higher incidence of bowel problems. The median annual risks for the development of distant metastases and cancer-related death were 2.6% and 1.0%, respectively. Because tumor grade was correlated with metastases (Spearman correlation r = .56) and cancer mortality (r = .31), controlling for grade was necessary before we could compare the effectiveness of treatments for these outcomes. However, stratification by grade of malignancy was available in only nine of the patient series describing metastatic rates and in seven describing cancer-related mortality. Furthermore, in the patient series that described prostate cancer-related metastatic rates, 48% neglected to identify patients unavailable for follow-up, 92% did not stratify patients by age, and only 48% stratified patients by the extent of disease at treatment.
CONCLUSIONS
Although we were able to compare complications of treatments, we were unable to determine treatment effectiveness for localized prostate cancer because of methodologic inadequacies in the literature we reviewed. Until better scientific evidence is available, patients and their physicians cannot make informed choices based on knowledge of the benefits of radical prostatectomy, radiation, or watchful waiting.