PDF(Pubmed)
Abstract：
There is controversy regarding the most effective primary treatment of choice for prostate cancer (PCa) in terms of patient outcomes, such as surgery or radiotherapy (RT). This study evaluated the comparative efficacy and long-term outcomes of radical prostatectomy (RP) and RT for PCa treatment. A thorough literature review of relevant databases was conducted, focusing on academic and clinical studies published from 2019 onwards. The inclusion criteria included randomized controlled trials (RCTs) and other observational studies comparing survival outcomes in patients treated with surgery and RT. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to provide an overview of the data. We selected 19 studies based on the inclusion criteria. Of the total 19 studies, 12 advocated RP as the preferred treatment to improve survival outcomes in patients with PCa. The results of our synthesis showed that prostate cancer-specific mortality (PCSM) was lower in patients treated with RT. The total effect size for the analysis was calculated as Z=1.19 (p-value=0.23). The heterogeneity in the studies was as follows: Tau2=0.09, Chi2=20.25, df=4, I2=80%. Moreover, overall survival (OS) was shown to be higher in patients who underwent prostatectomy. The combined effect for the analysis was found to be: HR=0.97 (0.93, 1.01). The total effect was calculated as Z=1.33 (p-value= 0.18). The heterogeneity was found to be Tau2=0.00, Chi2=1.33, df=2, and I2=0%. However, overall mortality (OM) was shown to be independent of the treatment modality. RT is the preferred strategy for PCa treatment, as it balances efficacy and long-term outcomes. Clinical decision-making should consider individual patient characteristics and future research should delve into specific subpopulations and long-term outcomes to further refine the treatment guidelines.
摘要：
就患者预后而言，关于前列腺癌（PCa）最有效的主要治疗方法存在争议，如手术或放射治疗（RT）。这项研究评估了前列腺癌根治术（RP）和RT治疗PCa的比较疗效和长期预后。对相关数据库进行了全面的文献综述，专注于2019年以来发表的学术和临床研究。纳入标准包括随机对照试验（RCT）和其他观察性研究，比较接受手术和RT治疗的患者的生存结果。我们遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目，以提供数据的概述。我们根据纳入标准选择了19项研究。在总共19项研究中，12主张RP作为改善PCa患者生存结果的首选治疗方法。我们的综合结果显示，接受RT治疗的患者的前列腺癌特异性死亡率（PCSM）较低。分析的总效应大小计算为Z=1.19(p值=0.23)。研究中的异质性如下:Tau2=0.09,Chi2=20.25,df=4,I2=80%。此外，结果显示,接受前列腺切除术的患者的总生存期(OS)更高.发现分析的组合效应为:HR=0.97(0.93,1.01)。总效应计算为Z=1.33(p值=0.18)。发现异质性为Tau2=0.00,Chi2=1.33,df=2,I2=0%。然而,总死亡率(OM)与治疗方式无关.RT是PCa治疗的首选策略，因为它平衡了疗效和长期结果。临床决策应考虑患者的个体特征，未来的研究应深入研究特定的亚群和长期结果，以进一步完善治疗指南。
