确定局部治疗后生化复发的打捞疗法：系统评价，荟萃分析和网络荟萃分析
Salvage therapies for biochemical recurrence after definitive local treatment: a systematic review, meta-analysis, and network meta-analysis
影响因子:5.80000
发表日期:2024 Sep 13
作者:
Akihiro Matsukawa, Takafumi Yanagisawa, Tamas Fazekas, Marcin Miszczyk, Ichiro Tsuboi, Mehdi Kardoust Parizi, Ekaterina Laukhtina, Jakob Klemm, Stefano Mancon, Keiichiro Mori, Shoji Kimura, Jun Miki, Juan Gomez Rivas, Timo F W Soeterik, Thomas Zilli, Derya Tilki, Steven Joniau, Takahiro Kimura, Shahrokh F Shariat, Pawel Rajwa
摘要
局部治疗前列腺癌（PCA）（包括使用雄激素受体信号传导抑制剂（ARSIS）），生化复发（BCR）的最新进展已扩大了治疗方案的范围。我们旨在比较BCR患者的救助疗法在局部确定的临床非静态PCA治疗后具有治愈性。 （RT）。主要终点是无转移生存期（MFS），次要终点包括无进展生存率（PFS）和总生存期（OS）。我们包括19项研究（n = 9117）；六项试验分析了RP后基于RT的策略，十项试验仅在RP±RT或RT之后分析了基于激素的策略，并分析了三项试验，分析了其他药物。在一项成对的荟萃分析中，与单独的RT相比，在挽救RT中增加激素治疗可显着改善MFS（HR：0.69，95％CI：0.57-0.84，P <0.001）。基于治疗排名分析，在基于RT的策略中，人们发现，在MFS方面，添加了选择性淋巴结RT和雄激素剥夺疗法（ADT）是最有效的。另一方面，在基于激素的策略中，enzalutamide+ADT对MFS和OS均显示出最大的好处。前列腺床RT，选择性骨盆辐射和ADT的结合是基于我们的分析的合格患者的首选治疗方法。在剩下的患者中，或者在RT后复发的情况下，尤其是对于患有高危BCR的患者，应考虑ADT和ARSI的组合。
Abstract
Recent advancements in the management of biochemical recurrence (BCR) following local treatment for prostate cancer (PCa), including the use of androgen receptor signaling inhibitors (ARSIs), have broadened the spectrum of therapeutic options. We aimed to compare salvage therapies in patients with BCR after definitive local treatment for clinically non-metastatic PCa with curative intent.In October 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled trials (RCTs) and prospective studies reporting data on the efficacy of salvage therapies in PCa patients with BCR after radical prostatectomy (RP) or radiation therapy (RT). The primary endpoint was metastatic-free survival (MFS), and secondary endpoints included progression-free survival (PFS) and overall survival (OS).We included 19 studies (n = 9117); six trials analyzed RT-based strategies following RP, ten trials analyzed hormone-based strategies following RP ± RT or RT alone, and three trials analyzed other agents. In a pairwise meta-analysis, adding hormone therapy to salvage RT significantly improved MFS (HR: 0.69, 95% CI: 0.57-0.84, p < 0.001) compared to RT alone. Based on treatment ranking analysis, among RT-based strategies, the addition of elective nodal RT and androgen deprivation therapy (ADT) was found to be the most effective in terms of MFS. On the other hand, among hormone-based strategies, enzalutamide + ADT showed the greatest benefit for both MFS and OS.The combination of prostate bed RT, elective pelvic irradiation, and ADT is the preferred treatment for eligible patients with post-RP BCR based on our analysis. In remaining patients, or in case of post-RT recurrence, especially for those with high-risk BCR, the combination of ADT and ARSI should be considered.