| 21 | 0 | 42 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 系统评价前列腺癌根治术（RP）联合内分泌治疗对寡转移性前列腺癌（OmPCa）患者预后的影响。方法 本研究将OmPCa明确定义为：1～5个骨和（或）淋巴结转移病灶（排除内脏转移）。内分泌治疗限定为传统药物去势治疗（不含阿比特龙等新型内分泌药物）。检索中英文数据库（截至2025年3月1日），纳入比较RP联合内分泌治疗（联合治疗组）与内分泌治疗（单纯治疗组）OmPCa的临床研究。采用RevMan 5.4软件进行Meta分析，计算风险比（HR）及95%置信区间（CI）。结果 共纳入13项研究（1 120例患者）。Meta分析结果表明，联合治疗组影像学无进展生存期（rPFS,HR=0.41,95%CI:0.30～0.55,P<0.00001）、去势抵抗无进展生存期（CRFS,HR=0.57,95%CI:0.47～0.70,P<0.00001）、肿瘤特异性生存期（CSS,HR=0.41,95%CI:0.31～0.55,P<0.00001）、总生存期（OS,HR=0.53,95%CI:0.37～0.75,P=0.0004）及并发症发生率（RD=-0.23,95%CI:-0.32～-0.14,P<0.00001）均显著优于单纯治疗组，且均不存在显著异质性（I2<50%）。结论 RP联合内分泌治疗可改善OmPCa患者预后，但临床决策仍需综合评估患者个体化特征与手术风险。
Abstract：Objective To systematically evaluate the effect of radical prostatectomy(RP) combined with endocrine therapy on the prognosis of patients with oligometastatic prostate cancer(OmPCa). Methods In this study, OmPCa was clearly defined as 1 – 5 bone and/or lymph node metastatic lesions(excluding visceral metastases). Endocrine therapy was limited to traditional medical castration therapy(excluding novel endocrine agents such as abiraterone). Chinese and English databases were searched(up to March 1, 2025) to include clinical studies comparing RP combined with endocrine therapy(combined treatment group) and endocrine therapy alone(single treatment group) for OmPCa. Meta-analysis was performed using RevMan 5.4 software, and hazard ratios(HR) with 95% confidence intervals(CI) were calculated. Results A total of 13 studies involving 1,120 patients were included. The results of Meta-analysis showed that the combined treatment group was significantly superior to the single treatment group in terms of radiologic progression-free survival(rPFS, HR=0.41,95%CI:0.30–0.55, P<0.00001), castration-resistant progression-free survival(CRFS, HR=0.57,95%CI:0.47–0.70, P<0.00001), cancer-specific survival(CSS, HR=0.41,95%CI:0.31 – 0.55, P<0.00001), overall survival(OS, HR=0.53,95%CI:0.37–0.75, P=0.0004), and complication rate(RD=-0.23,95%CI:-0.32–-0.14, P<0.00001). No significant heterogeneity was observed for all outcomes(I2 <50%). Conclusion RP combined with endocrine therapy can improve the prognosis of patients with OmPCa, but clinical decisions still need to comprehensively evaluate the individual characteristics of patients and surgical risks.
[1]Hellman S, Weichselbaum RR. Oligometastases[J]. J Clin Oncol,1995,13(1):8-10.
[2]Vogelstein B, Kinzler KW. The multistep nature of cancer[J].Trends Genet,1993,9(4):138-141.
[3]Weichselbaum RR, Hellman S. Oligometastases revisited[J].Nat Rev Clin Oncol,2011,8(6):378-382.
[4]Cornford P, Van Den Bergh RCN, Briers E, et al. EAUEANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer—2024 Update. Part I:Screening, Diagnosis, and Local Treatment with Curative Intent[J]. Eur Urol, 2024, 86(2):148-163.
[5]Nazzani S, Mazzone E, Preisser F, et al. Comparison of perioperative outcomes between open and robotic radical cystectomy:A population-based analysis[J]. J Endourol, 2018, 32(8):701-709.
[6]Leyh-Bannurah SR, Gazdovich S, Bud??us L, et al. Local therapy improves survival in metastatic prostate cancer[J]. Eur Urol,2017,72(1):118-124.
[7]Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA2020 statement:an updated guideline for reporting systematic reviews[J]. Syst Rev,2021,10(1):89.
[8]Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis[J]. Trials,2007,8(1):16.
[9]Schmeller N, Lubos W. Early endocrine therapy versus radical prostatectomy combined with early endocrine therapy for stage D1prostate cancer[J]. Br J Urol,1997,79(2):226-234.
[10]Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases:results of a feasibility and case-control study[J]. J Urol,2015,193(3):832-838.
[11]Moschini M, Morlacco A, Kwon E, et al. Treatment of M1a/M1b prostate cancer with or without radical prostatectomy at diagnosis[J]. Prostate Cancer Prostatic Dis, 2017, 20(1):117-121.
[12]Steuber T, Berg KD, R??der MA, et al. Does cytoreductive prostatectomy really have an impact on prognosis in prostate cancer patients with low-volume bone metastasis? Results from a prospective case-control study[J]. Eur Urol Focus, 2017, 3(6):646-649.
[13]Jang WS, Kim MS, Jeong WS, et al. Does robot-assisted radical prostatectomy benefit patients with prostate cancer and bone oligometastases?[J]. BJU Int,2018,121(2):225-231.
[14]周鑫.减瘤性前列腺根治术联合内分泌治疗对寡量骨转移患者临床疗效的观察性研究[D].西安：中国人民解放军空军军医大学，2019.
[15]Lan T, Chen Y, Su Q, et al. Oncological outcome of cytoreductive radical prostatectomy in prostate cancer patients with bone oligometastases[J]. Urology,2019,131:166-175.
[16]Si S, Zheng B, Wang Z, et al. Does surgery benefit patients with oligometastatic or metastatic prostate cancer?-A retrospective cohort study and meta-analysis[J]. Prostate, 2021, 81(11):736-744.
[17]Lumen N, De Bleser E, Buelens S, et al. The role of cytoreductive radical prostatectomy in the treatment of newly diagnosed low-volume metastatic prostate cancer. Results from the local treatment of metastatic prostate cancer(LoMP)registry[J]. Eur Urol Open Sci,2021,29:68-76.
[18]袁志，盛欧阳，刘启航，等.机器人辅助腹腔镜根治性前列腺切除术治疗寡转移性前列腺癌疗效分析[J].现代泌尿外科杂志，2021,26(11):934-938.
[19]Mistretta FA, Luzzago S, Conti A, et al. Oligometastatic prostate cancer:A comparison between multimodality treatment vs.androgen deprivation therapy alone[J]. Cancers, 2022, 14(9):2313.
[20]Dai B, Zhang S, Wan FN, et al. Combination of androgen deprivation therapy with radical local therapy versus androgen deprivation therapy alone for newly diagnosed oligometastatic prostate cancer:A Phase II randomized controlled trial[J]. Eur Urol Oncol,2022,5(5):519-525.
[21]丁琪，孙慕斌，金晓华，等.减瘤性前列腺癌根治术联合内分泌治疗在寡转移前列腺癌患者中的疗效及预后观察[J].实用医学杂志，2023,39(4):460-464.
[22]Ilic D, Evans SM, Allan CA, et al. Laparoscopic and robot-assisted vs open radical prostatectomy for the treatment of localized prostate cancer:a Cochrane systematic review[J]. BJU Int,2018,121(6):845-853.
[23]Porpiglia F, Fiori C, Bertolo R, et al. Five-year outcomes for a prospective randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy[J]. Eur Urol Focus,2018,4(1):80-86.
[24]Okegawa T, Omura S, Samejima M, et al. Laparoscopic radical prostatectomy versus robot-assisted radical prostatectomy:comparison of oncological outcomes at a single center[J]. Prostate Int,2020,8(1):16-21.
[25]Ma J, Xu W, Chen R, et al. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer:the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies[J]. Int J Surg, 2023, 109(5):1350-1359.
[26]Culp MB, Soerjomataram I, Efstathiou JA, et al. Recent global patterns in prostate cancer incidence and mortality rates[J].Eur Urol,2020,77(1):38-52.
[27]James ND, Tannock I, N’Dow J, et al. The lancet commission on prostate cancer:planning for the surge in cases[J].Lancet,2024,403(10437):1683-1722.
[28]Siegel RL, Miller KD, Jemal A. Cancer statistics,2020[J].CA Cancer J Clin,2020,70(1):7-30.
[29]卞晓洁，叶定伟.前列腺癌雄激素剥夺治疗的新思路—睾酮最大控制临床研究新进展[J].中国癌症杂志，2021,31(12):1209-1214.
[30]Sheng M, Guo S, Liu C. Circulating tumor cells in patients undergoing androgen deprivation therapy with versus without cryosurgery for metastatic prostate cancer:a retrospective analysis[J]. World J Surgl Oncol,2021,19(1):345.
[31]Rapiti E, Verkooijen HM, Vlastos G, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis[J]. J Clin Oncol, 2006, 24(18):2743-2749.
[32]Steuber T, Bud??us L, Walz J, et al. Radical prostatectomy improves progression-free and cancer-specific survival in men with lymph node positive prostate cancer in the prostate-specific antigen era:a confirmatory study[J]. BJU Int, 2011, 107(11):1755-1761.
[33]Unger JM, Till C, Tangen CM, et al. long-term adverse effects and complications after prostate cancer treatment[J]. JAMA Oncol, 2024,10(12):1654–1662.
基本信息:
DOI：10.19558/j.cnki.10-1020/r.2025.06.009
中图分类号:R737.25
引用信息:
[1]董宇杰,罗锦,李卓然,等.前列腺癌根治术联合内分泌治疗寡转移性前列腺癌的Meta分析[J].微创泌尿外科杂志,2025,14(06):407-415.DOI:10.19558/j.cnki.10-1020/r.2025.06.009.
基金信息:
国家自然科学基金（82372704）; 国家重点研发计划（2023YFC3606000）;国家重点研发计划（2023YFC3606005）
2025-04-03
2025
2025-11-27
2025
1
2025-12-28
2025-12-28