前列腺癌间歇与持续性内分泌治疗疗效比较的Meta分析

目的通过Meta分析对间歇性内分泌治疗(IHT)与持续性内分泌疗法(CHT)治疗前列腺癌的疗效进行综合分析。方法通过Pubmed、EMbase、Science Direct、万方、中国知网等数据库检索自1990至2018年相关文献,并手工检索国内外相关杂志。Jadad质量记分法评估纳入研究的质量。治疗组(IHT组)患者使用间歇性内分泌疗法,对照组(CHT组)患者使用持续性内分泌疗法。Meta分析评价两组总体生存率、肿瘤进展期、肿瘤特异性生存率、无进展生存率、去势抵抗时间、生活质量、不良反应发生率。结果本研究纳入16篇文献,共计8400例病例。治疗组与对照组治疗前列腺癌(PCa)风险比比较,总体生存率(HR=1.02,P=0.62)、肿瘤进展期(HR=0.93,P=0.11)、肿瘤特异性生存率(HR=0.99,P=0.93)、无进展生存率(HR=1.01,P=0.41),比较差异无统计学意义。在患者去势抵抗时间方面,IHT组比CHT组更具优势(HR=0.80,P=0.02)。IHT组生活质量评分较CHT组明显升高(P<0.05),IHT组的一些不良反应发生率也较CHT组显著降低(P<0.05),如面部潮热、男性乳房胀痛增生、头痛,生活质量评分明显升高(P<0.05)。结论使用IHT和CHT治疗PCa的生存率差异无统计学意义,但IHT能够提高生存质量,降低患者不良反应的发生率,延缓进展至非激素依赖性前列腺癌的时间,降低用药剂量及治疗费用,值得临床推广。

The curative effect analysis of intermittent vs continuous hormonal therapy for prostate cancer:a Meta-analysis

Objective To assess the efficacy of intermittent hormonal therapy(IHT)versus continuous hormonal therapy(CHT)for prostate cancer through Meta-analysis.Methods We searched PubMed,EMbase,Science Direct,Wanfang,CNKI for randomized control trials and their references from 1990 to 2018.The qualities of the included studies were evaluated by the Jadad scale.The treatment group means patients who received the intermittent endocrine therapy,and the control group means patients who received the continuous endocrine therapy.Then we evaluated overall survival(OS),time to progression(TTP),cancer specific survival(CSS),progression free survival(PFS),time to castration resistance,quality of life and the incidence of side effects by Meta-analysis.Results Totally,16 randomized trials involving 8400 patients were included.Comparing control group with treatment group,there were no significant difference in OS(HR=1.02,P=0.62),TTP(HR=0.93,P=0.11),CSS(HR=0.99,P=0.93)and PFS(HR=1.01,P=0.41).Compared with CHT,IHT showed significant advantages in time to castration resistance(HR=0.80,P=0.02)and quality of life(P<0.05).Some adverse reactions after treatment significantly reduced in IHT group than CHT group(P<0.05),such as hot flushes,gynecomastia and headache.Conclusions The survival rates of patients with prostate cancer after IHT and CHT is not significantly different,but IHT can reduce the incidence of adverse reactions,improve quality of life,delay the progression to androgen-independent prostate cancer,reduce the dose and treatment costs,is worthy of clinical wide vertebra.