最大雄激素治疗转移性前列腺癌的封锁,系统回顾。
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Lukka H,沃尔德伦T,克洛茨L, Winquist E,特拉亨伯格J
最大雄激素治疗转移性前列腺癌的封锁,系统回顾。
咕咕叫杂志。2006年6月,13 (3):81 - 93。
- PubMed ID
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17576447 (在PubMed]
- 文摘
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简介:最大雄激素封锁(MAB)与阉割独自在转移性前列腺癌患者在随机试验被广泛评价。不一致的结果导致了出版的多个荟萃分析。目前文献的证据整合报告来确定是否使用代理如flutamide马伯,nilutamide,醋酸环丙孕酮(CPA)与一种生存优势。方法:我们进行了一项系统回顾文献(MEDLINE和EMBASE,通过2004年7月和Cochrane图书馆;CANCERLIT通过2002年10月),而单独阉割马伯的荟萃分析在以前未经治疗转移性前列腺癌的男性(D1或D2, N + / M0、M1)。两个评论家选择论文资格;分歧是由所有作者通过协商解决。结果:文献检索发现6个荟萃分析,达到合格标准的审必威国际app查。两个报告是基于个体患者数据(IPD),四是基于数据从出版的文献。所有六个荟萃分析池总生存期的数据。 The best evidence came from the largest meta-analysis, conducted by the Prostate Cancer Trialists Collaborative Group and based on IPD (8725 patients) from 27 trials. That analysis detected no difference in overall survival between mab and castration alone at 2 or 5 years. However, a subgroup analysis showed that MAB with nonsteroidal anti-androgens (NSAAS) was associated with a statistically significant improvement in 5-year survival over castration alone (27.6% vs. 24.7%; p = 0.005). The combination of MAB with CPA, a steroidal anti-androgen, was associated with a statistically significant increased risk of death (15.4% vs. 18.1%; p = 0.04). Compared with castration alone, MAB was associated with more side effects (that is, gastrointestinal, endocrine function) and reduced quality of life in domains related to treatment symptoms and emotional functioning. CONCLUSIONS: The small survival benefit conferred by MAB with NSAA is of questionable clinical significance given the added toxicity and concomitant decline in quality of life observed in patients treated with MAB. Therefore, combined treatment with flutamide or nilutamide should not be routinely offered to patients with meta-static prostate cancer beyond the purpose of blocking testosterone flare. Monotherapy, consisting of orchiectomy or the administration of a luteinizing hormone-releasing hormone agonist is recommended as standard treatment.
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