Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

ABSTRACT Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

【摘要】
背景：目前，转移性前列腺癌（metastatic prostatic cancer, MPCa）的标准治疗方案为雄激素剥夺疗法（androgen-deprivation therapy, ADT）。近期研究表明，正如其他肿瘤中的研究结果所示，转移性前列腺癌的局部治疗可提升患者的生存获益。
研究目的：评估局部治疗对转移性前列腺癌患者3年总生存期（Overall Survival, OS）与癌症特异性生存期（Cancer Specific Survival, CSS）的影响。
资料与方法：对2016年6月之前发表于PubMed、SciELO、LILACS、Cochrane及EMBASE数据库的人群研究进行系统综述与荟萃分析。纳入多项大型队列研究及Post-Roc研究，这些研究评估了接受局部治疗（local treatment, LT，包括放疗（radiotherapy, RDT）、手术（surgery, RP）或近距离放射治疗（brachytherapy, BCT））或未接受局部治疗（non-local treatment, NLT）的转移性前列腺癌患者。
结果：共纳入6项研究，分析34338例患者，其中31653例接受NLT，2685例接受LT。接受LT的患者3年总生存期显著高于NLT组（64.2% vs. 44.5%；风险差（Risk Difference, RD）=0.19，95%置信区间（Confidence Interval, CI）：0.17~0.21；p<0.00001；I²=0%）；5年总生存期亦表现出显著优势（51.9% vs. 23.6%；RD=0.30，95%CI：0.11~0.49；p<0.00001；I²=97%）。按局部治疗类型进行的敏感性分析显示，手术组（78.2% vs. 45.0%；RD=0.31，95%CI：0.26~0.35；p<0.00001；I²=50%）与放疗组（60.4% vs. 44.5%；RD=0.17，95%CI：0.12~0.22；p<0.00001；I²=67%）均获得了更优的临床结局。
结论：采用放疗、手术或近距离放射治疗的局部治疗方案，可显著改善转移性前列腺癌患者的总生存期与癌症特异性生存期。未来需开展前瞻性随机对照研究以验证本研究结果。