Neo-adjuvant hormone therapy for non-metastatic prostate cancer: a systematic review and meta-analysis of 5,194 patients
Neo-adjuvant hormone therapy for non-metastatic prostate cancer: a systematic review and meta-analysis of 5,194 patients
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DOI：
10.1186/s12957-015-0503-z
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发表时间：
2015-02-22
影响因子：
3.2
通讯作者：
Jiang, Haowen
中科院分区：
文献类型：
--
作者：
Hu, Jimeng;Xu, Hua;Jiang, Haowen
背景资料：根治性前列腺切除术（RP）或放疗后的新辅助激素治疗（NHT）已被用于中高危前列腺癌（PCa）患者的多模式方法。在此，我们进行了系统评价和荟萃分析的随机试验，以评估NHT的临床疗效。方法：文献检索PubMed，EMBASE，Web of Science，和科克伦图书馆比较新辅助治疗组（NHT加放疗或根治性乳腺癌切除术）与传统治疗（放疗或乳腺癌切除术）单独。采用科克伦随机对照试验偏倚风险评价研究质量。从合格的试验中获得可比信息，并汇总至2014年8月31日进行荟萃分析。结果：共纳入15篇随机对照试验（RCT），共5,194例患者。Meta分析显示，总生存期（OS）显著改善（比值比（OR）= 1.51，95%置信区间（CI）1.22 - 1.87，P = 0.0002），手术切缘阳性（PSM）率（OR = 0.30，95% CI 0.24 - 0.38，P < 0.00001），生化无病生存期（bDFS）（OR = 1.95，95%CI 1.13 ~ 3.39，P = 0.02），但无病生存期无显著差异（OR = 1.52，95%CI 0.90 ~ 2.59，P = 0.12）和临床无病生存期（cDFS）（OR = 0.96，95%CI 0.22 ~ 4.18，P = 0.95）。异源性和风险的偏倚之间观察到不同的研究。结论：侵袭性前列腺癌患者将更好地受益于接受新辅助治疗。医生应根据不良反应、经济能力和个人意愿制定个体化治疗策略。
Background: Neo-adjuvant hormone therapy (NHT) following radical prostatectomy (RP) or radiotherapy has been utilized in the multimodal approach to patients with intermediate-to high-risk prostate cancer (PCa). Herein, we performed a systematic review and meta-analysis of published randomized trials to evaluate the clinical efficacy of NHT.Methods: Literatures were searched from PubMed, EMBASE, Web of Science, and Cochrane Library for comparing neo-adjuvant therapy group (NHT plus radiotherapy or radical prostatectomy) with traditional therapy (radiotherapy or prostatectomy) alone. Quality of the research was assessed on the basis of the Cochrane's risk of bias of randomized controlled trial. Comparable information were obtained from eligible trials and assembled for meta-analysis up to 31 August 2014. RevMan 5.2 software was used for statistical analysis.Results: Fifteen randomized controlled trials (RCTs) (total 5,194 patients) were included in this study. Meta-analysis showed there was a significant improvement in overall survival (OS) (Odds ratio (OR) = 1.51, 95% confidence interval (CI) 1.22 to 1.87, P = 0.0002), positive surgical margin (PSM) rate (OR = 0.30, 95% CI 0.24 to 0.38, P < 0.00001), and biochemical disease-free survival (bDFS) (OR = 1.95, 95% CI 1.13 to 3.39, P = 0.02), but no significant difference in disease-free survival (OR = 1.52, 95% CI 0.90 to 2.59, P = 0.12) and clinical disease-free survival (cDFS) (OR = 0.96, 95% CI 0.22 to 4.18, P = 0.95). Heterogeneity and risk of bias were observed between different studies.Conclusions: Patients with aggressive prostate cancer would better benefit from the receipt of neo-adjuvant therapy. Physicians should make individualized treatment strategies according to adverse reactions, financial capacities, and personal wishes.