背景:尽管缺乏一级证据,转移定向治疗(MDT)广泛应用于转移性前列腺癌(mPCa)患者的治疗.数据从精心设计的前瞻性研究中不断涌现。
目的:总结并报告MDT在mPCa患者治疗中的肿瘤学和安全性结果的证据。
方法:我们搜索了PubMed,Scopus,和WebofScience数据库,用于评估无进展生存期(PFS)的前瞻性研究,本地控制(LC),雄激素剥夺治疗(ADT)无生存(ADT-FS),总生存期(OS),和/或不良事件(AE)的mPCa患者接受MDT治疗。对1年和2年PFS进行了荟萃分析,LC,ADT-FS,操作系统,和AE率。进行荟萃回归和敏感性分析以解释异质性并确定调节因素。
结果:我们确定了22项前瞻性研究(n=1137),包括两项随机对照试验(n=116)。两项研究被排除在荟萃分析之外(n=120)。排除使用生化或ADT相关终点的研究后,估计的2年PFS为46%(95%置信区间[CI]:36-56%)或42%(95%CI:33-52%)。估计的2年LC,ADT-FS,OS为97%(95%CI:94-98%),55%(95%CI:44-65%),和97%(95%CI:95-98%),分别。治疗相关的2级和≥3级不良事件发生率为2.4%(95%CI:0.2-7%)和0.3%(95%CI:0-1%),分别。
结论:MDT是一种与有利PFS相关的有希望的治疗策略,优秀的LC,低毒性,允许低复发激素敏感患者避免或推迟ADT相关毒性。MDT与其他疗法的整合提供了一个有前途的研究方向,特别是,与全身治疗相结合,并作为寡转移PCa明确治疗的组成部分。然而,在没有随机试验的情况下,使用MDT进行强化治疗仍然是一种实验性方法,对操作系统的影响是不确定的。
结果:对于选定的前列腺癌患者,直接治疗转移是一个有希望的选择。它可以延迟激素治疗,并且正在研究以可控制的毒性为代价的强化治疗方法。
BACKGROUND: Despite the lack of level 1 evidence, metastasis-directed therapy (MDT) is used widely in the management of metastatic prostate cancer (mPCa) patients. Data are continuously emerging from well-designed prospective studies.
OBJECTIVE: To summarise and report the evidence on oncological and safety outcomes of MDT in the management of mPCa patients.
METHODS: We searched the PubMed, Scopus, and Web of Science databases for prospective studies assessing progression-free survival (PFS), local control (LC), androgen deprivation therapy (ADT)-free survival (ADT-FS), overall survival (OS), and/or adverse events (AEs) in mPCa patients treated with MDT. A meta-analysis was performed for 1- and 2-yr PFS, LC, ADT-FS, OS, and rate of AEs. Meta-regression and sensitivity analysis were performed to account for heterogeneity and identify moderators.
RESULTS: We identified 22 prospective studies (n = 1137), including two randomised controlled trials (n = 116). Two studies were excluded from the meta-analysis (n = 120). The estimated 2-yr PFS was 46% (95% confidence interval [CI]: 36-56%) or 42% (95% CI: 33-52%) after excluding studies using biochemical or ADT-related endpoints. The estimated 2-yr LC, ADT-FS, and OS were 97% (95% CI: 94-98%), 55% (95% CI: 44-65%), and 97% (95% CI: 95-98%), respectively. Rates of treatment-related grade 2 and ≥3 AEs were 2.4% (95% CI: 0.2-7%) and 0.3% (95% CI: 0-1%), respectively.
CONCLUSIONS: MDT is a promising treatment strategy associated with favourable PFS, excellent LC, and a low toxicity profile that allows oligorecurrent hormone-sensitive patients to avoid or defer ADT-related toxicity. Integration of MDT with other therapies offers a promising research direction, in particular, in conjunction with systemic treatments and as a component of definitive care for
oligometastatic PCa. However, in the absence of randomised trials, using MDT for treatment intensification remains an experimental approach, and the impact on OS is uncertain.
RESULTS: Direct treatment of metastases is a promising option for selected prostate cancer patients. It can delay hormone therapy and is being investigated as a way of intensifying treatment at the expense of manageable toxicity.