背景:已知运动可以减少雄激素剥夺疗法(ADT)对生活质量的不良副作用,前列腺癌(PCa)患者的骨骼健康和疲劳。我们进行了一项系统评价和荟萃分析,以评估多学科干预对ADT治疗的PCa患者身体成分和代谢综合征(MetS)的影响。
方法:根据EMBASE的搜索进行系统综述和荟萃分析,MEDLINE,CENTRAL和Scopus数据库从成立到2023年3月。参与者包括接受ADT治疗的PCa患者,他们接受了包括运动在内的多学科干预,饮食,营养,药物治疗,减肥手术,或心理/行为疗法。主要结果是身体成分和代谢综合征的变化,前列腺特异性抗原(PSA)作为次要结果。经过荟萃分析,结果以平均差报告,95%置信区间和p值,森林地块。此外,我们进行了亚组分析,以比较不同干预措施的效果.
结果:1443篇文章中有33篇文章符合资格标准,28项研究纳入荟萃分析。在33项研究中,17包括仅运动干预,10包括运动+饮食/营养干预,但没有研究包括饮食/营养干预措施。所有研究都采用多学科方法来开发或提供干预措施。大多数研究(85%)有低-中度的偏倚风险,从而为这次审查提供了很好的证据。总的来说,干预措施对身体成分测量有积极影响;瘦体重(LM):0.82kg(95%CI:0.47,1.17;p<0.00001),体脂质量(BFM):-0.68kg(95%CI:-1.12,-0.24;p=0.002),无脂质量:0.75kg(95%CI:0.14,1.37;p=0.02)和体脂百分比(BFP):-0.99%(95%CI:-1.29,-0.68;p<0.00001),以及MetS;腰围:-1.95厘米(95%CI:-3.10,-0.79;p=0.0009),收缩压:-3.43mmHg(95%CI:-6.36,-0.50;p=0.02)和舒张压:-2.48mmHg(95%CI:-4.19,-0.76;p=0.005)。亚组分析表明,包括运动+饮食/营养在内的组合方法在改善BFP方面最有效,WC,SBP和DBP,而运动对改善LM和BFM更有效。
结论:在接受ADT治疗的PCa患者中,多学科干预措施,尤其是那些结合运动和饮食/营养的人,可以改善身体成分和代谢健康。
Exercise is known to reduce adverse side effects of androgen-deprivation therapy (ADT) on quality of life, bone health and fatigue for prostate cancer (PCa) patients. We conducted a systematic
review with meta-analysis to evaluate the effect of multidisciplinary interventions on body composition and metabolic syndrome (MetS) in ADT-treated PCa patients.
A systematic
review and meta-analysis were conducted based on searches of EMBASE, MEDLINE, CENTRAL and Scopus databases from inception to March 2023. Participants included ADT-treated PCa patients who received multidisciplinary interventions including exercise, diet, nutrition, pharmacotherapy, bariatric surgery, or psychological/behavioural therapy. Primary outcomes were changes in body composition and MetS, with prostate-specific antigen (PSA) as a secondary outcome. After meta-analysis, results were reported in mean difference, 95% confidence interval and p-value, with forest plots. Additionally, we conducted subgroup analyses to compare the effect of different interventions.
Thirty-three articles met the eligibility criteria out of 1443 articles and 28 studies were included in meta-analysis. Of 33 studies, 17 included exercise-only interventions and 10 included exercise + diet/nutrition interventions, but no studies included diet/nutrition-only interventions. All studies employed multidisciplinary approaches in developing or delivering the interventions. Most studies (85%) had low-moderate risk of bias, thus providing good evidence to this
review. Overall, interventions had a positive effect on body composition measures; lean mass (LM):0.82 kg (95% CI:0.47,1.17;p < 0.00001), body fat mass (BFM):-0.68 kg (95% CI:-1.12,-0.24;p = 0.002), fat-free mass:0.75 kg (95% CI:0.14,1.37;p = 0.02) and body fat percentage (BFP):-0.99% (95% CI:-1.29,-0.68;p < 0.00001), as well as on MetS; waist circumference:-1.95 cm (95% CI:-3.10,-0.79;p = 0.0009), systolic blood pressure:-3.43 mmHg (95% CI:-6.36,-0.50;p = 0.02) and diastolic blood pressure:-2.48 mmHg (95% CI:-4.19,-0.76;p = 0.005). Subgroup-analyses showed that a combined approach including exercise + diet/nutrition was most effective in improving BFP, WC, SBP and DBP whereas exercise was more effective in improving LM and BFM.
In ADT-treated PCa patients, multidisciplinary interventions, especially those combining exercise and diet/nutrition, can improve body composition and metabolic health.