背景:目前尚不清楚原发性局部肿瘤的治疗程度。如根治性前列腺切除术(RP)和放射治疗(RT),改善低体积转移性激素敏感型前列腺癌(mHSPC)患者的总生存率.然而,数据表明,这些疗法在预防局部肿瘤进展继发的局部事件方面有益处.
目的:为了评估在全身治疗中增加局部治疗(RP或RT)的疗效,包括雄激素剥夺治疗,多西他赛,和/或雄激素受体轴靶向药物,在预防mHSPC患者的局部事件方面,与单独的全身治疗相比(即,没有前列腺或RP的RT)。
方法:在2023年11月查询了三个数据库和会议摘要,用于分析接受局部治疗的mHSPC患者的研究。感兴趣的主要结果是预防整体局部事件(尿路感染,尿路梗阻,和肉眼血尿)由于局部疾病进展。根据局部治疗(RP或RT)的类型,进行亚组分析以评估差异结果。
结果:总体而言,六项研究,包括两项随机对照试验,纳入系统评价和荟萃分析。局部治疗加全身治疗组的局部事件总发生率显著低于仅全身治疗组(相对危险度[RR]:0.50,95%可信区间[CI]:0.28-0.88,p=0.016)。RP显着降低了整体局部事件的发生率(RR:0.24,95%CI:0.11-0.52)和需要手术干预的局部事件的发生率(RR:0.08,95%CI:0.03-0.25)。尽管在整体局部事件方面,RT加全身治疗组和仅全身治疗组之间没有统计学上的显着差异,需要手术干预的局部事件发生率在RT+全身治疗组显著较低(RR:0.70,95%CI:0.49~0.99);需要上尿路手术干预的局部事件发生率在局部治疗组显著较低(RR:0.60,95%CI:0.37~0.98,p=0.04).然而,一项亚组分析显示,RP和RT均不显著影响需要上尿路手术干预的局部事件的预防.
结论:在一些mHSPC患者中,原发性肿瘤的RP或RT似乎降低了局部进展和需要手术干预的事件的发生率。确定哪些患者最有可能从局部治疗中受益,以及在什么时间点(例如,转移反应后),将有必要建立一项评估风险的研究,好处,以及在mHSPC环境中原发性肿瘤治疗的替代方案。
结果:我们的研究表明,前列腺的局部治疗,如前列腺癌根治术或放疗,在转移性激素敏感型前列腺癌患者中可以预防局部事件,如尿路梗阻和肉眼血尿。
BACKGROUND: It remains unclear to what extent the therapy of the primary local tumor, such as radical prostatectomy (RP) and radiation therapy (RT), improves overall survival in patients with low-volume metastatic hormone-sensitive prostate cancer (mHSPC). However, data suggest a benefit of these therapies in preventing local events secondary to local tumor progression.
OBJECTIVE: To evaluate the efficacy of adding local therapy (RP or RT) to systemic therapies, including androgen deprivation therapy, docetaxel, and/or androgen receptor axis-targeted agents, in preventing local events in mHSPC patients compared with systemic therapy alone (ie, without RT of the prostate or RP).
METHODS: Three databases and meeting abstracts were queried in November 2023 for studies analyzing mHSPC patients treated with local therapy. The primary outcome of interest was the prevention of overall local events (urinary tract infection, urinary tract obstruction, and gross hematuria) due to local disease progression. Subgroup analyses were conducted to assess the differential outcomes according to the type of local therapy (RP or RT).
RESULTS: Overall, six studies, comprising two randomized controlled trials, were included for a systematic review and meta-analysis. The overall incidence of local events was significantly lower in the local treatment plus systemic therapy group than in the systemic therapy only groups (relative risk [RR]: 0.50, 95% confidence interval [CI]: 0.28-0.88, p = 0.016). RP significantly reduced the incidence of overall local events (RR: 0.24, 95% CI: 0.11-0.52) and that of local events requiring surgical intervention (RR: 0.08, 95% CI: 0.03-0.25). Although there was no statistically significant difference between the RT plus systemic therapy and systemic therapy only groups in terms of overall local events, the incidence of local events requiring surgical intervention was significantly lower in the RT plus systemic therapy group (RR: 0.70, 95% CI: 0.49-0.99); local events requiring surgical intervention of the upper urinary tract was significantly lower in local treatment groups (RR: 0.60, 95% CI: 0.37-0.98, p = 0.04). However, a subgroup analysis revealed that neither RP nor RT significantly impacted the prevention of local events requiring surgical intervention of the upper urinary tract.
CONCLUSIONS: In some patients with mHSPC, RP or RT of primary tumor seems to reduce the incidence of local progression and events requiring surgical intervention. Identifying which patients are most likely to benefit from local therapy, and at what time point (eg, after response of metastases), will be necessary to set up a study assessing the risk, benefits, and alternatives to therapy of the primary tumor in the mHSPC setting.
RESULTS: Our study suggests that local therapy of the prostate, such as radical prostatectomy or radiotherapy, in patients with metastatic hormone-sensitive prostate cancer can prevent local events, such as urinary obstruction and gross hematuria.