中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (11): 1931-1934.doi: 10.3969/j.issn.1673-8225.2010.11.008

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

术前激素治疗在局限性前列腺癌治疗中的地位：一项基于6个随机对照试验的荟萃分析

李 涛1，2，杨克虎1，2，田金徽2，陈一戎3，李朝彬4，郭柏鸿3，李国平1，3，郭庆华5   

  1. 1兰州大学第一临床医学院，甘肃省兰州市 730000；
    2兰州大学循证医学中心，甘肃省兰州市  730000； 
    3甘肃省人民医院泌尿外科，甘肃省兰州市 730000；
    4陕西省宝鸡市妇幼保健院男科，陕西省宝鸡市  721000；
    5兰州大学第一医院男科，甘肃省兰州市  730000
  • 出版日期:2010-03-12 发布日期:2010-03-12
  • 通讯作者: 陈一戎，主任医师，博士生导师，甘肃省人民医院泌尿外科，甘肃省兰州市 730000 cyirong@yahoo.com
  • 作者简介:李 涛，男，1970年生，陕西省宝鸡市人，汉族，1992年西安医科大学临床医学专业毕业，在读硕士，主要从事泌尿外科与男科学方面的研究。

Role of preoperative hormone therapy in localised prostate cancer: Meta-analysis based on six randomized controlled trials

Li Tao1,2, Yang Ke-hu1,2, Tian Jin-hui2, Chen Yi-rong3, Li Chao-bin4, Guo Bai-hong3, Li Guo-ping3, Guo Qing-hua5   

  1. 1First Clinical College of Lanzhou University, Lanzhou 730000, Gansu Province, China;
    2Evidence Based Medicine Center of Lanzhou University, Lanzhou  730000, Gansu Province, China;
    3Department of Urinary Surgery, People’s Hospital of Gansu Province, Lanzhou   730000, Gansu Province, China;
    4Department of Andrology, Baoji Maternal and Child Health Hospital, Baoji   721000, Shaanxi Province, China;
    5Department of Andrology, First Hospital of Lanzhou University, Lanzhou  730000, Gansu Province, China
  • Online:2010-03-12 Published:2010-03-12
  • Contact: Chen Yi-rong, Chief physician, Doctoral supervisor, Department of Urinary Surgery, People’s Hospital of Gansu Province, Lanzhou 730000, Gansu Province, China cyirong@yahoo.com
  • About author:Li Tao, Studying for master’s degree, First Clinical College of Lanzhou University, Lanzhou 730000, Gansu Province, China

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摘要：

背景：研究已证实术前激素治疗减低了前列腺癌患者的临床分期和病理分期，减少了切缘阳性率，但是并没有提高患者的无病生存率。目前术前激素治疗前列腺癌的价值尚无定论。
目的：评价术前激素治疗在治疗局限性前列腺癌中的作用。
方法：计算机检索PubMed、EMBASE、Cochrane Library(2009年第4期)、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库中2009年10月前发表的文章，手工检索相关领域的杂志。纳入随机对照试验，经病理学及细胞学检查确诊为局限性前列腺癌的患者，性别和民族不限，没有严重的心肺疾病；排除晚期或是复发的前列腺癌患者。同时从纳入文献的参考文献中查找符合要求的随机对照试验。采用国际Cochrane协作组提供的Revman 5.0软件进行统计分析。主要评价无病生存率、切缘阳性率、淋巴结阳性率、精囊浸润率4个结局指标。
结果与结论：共纳入6篇随机对照试验合计1 027人，meta分析结果显示：与单纯的前列腺癌手术相比，术前激素治疗联合前列腺癌手术在无病生存率[RR=1.02，95%CI (0.89，1.17)]，淋巴结阳性率[RR=0.86，95%CI (0.47，1.57)]、精囊浸润率[RR=1.09， 95%CI (0.74，1.59)]方面差异无显著性意义，而在手术切缘阳性率[RR=0.46，95%CI (0.32，0.66)]方面差异有显著性意义。提示术前激素治疗联合前列腺癌根治术能减低局限性前列腺癌患者的手术切缘阳性率，但是并不能提高患者的无病生存率、淋巴结阳性率、精囊浸润率。

关键词: 激素, 前列腺切除术, 前列腺癌, 荟萃分析, 随机对照

Abstract:

BACKGROUND: Previous research has demonstrated that preoperative hormone therapy relieved clinical and pathological stages of prostatic carcinoma patients, reduced positive ratio of incisal margin; however, it did not increase disease-free survival rate. Worth of preoperative hormone therapy for prostatic carcinoma remains unclear.
OBJECTIVE: To assess the role of preoperative hormone therapy in localised prostate cancer.
METHODS: Articles were searched from PubMed, Embase, Cochrane Library (No. 4, 2009), Chinese biomedical literature database, Chinese Scientific Journals full-text database, and Chinese Journal full-text database (published before October, 2009). Randomized controlled trials which were diagnosed as localised prostate cancer using pathology and cytology were included. The sex and nationality were not limited, and patients did not have severe heart and lung diseases. Prostatic carcinoma which occurred later or repeatedly was excluded. Otherwise, randomized controlled trails which were coincidence with the inclusion criteria were also included. Review Manager 5.0 published by Cochrane was used for statistical analysis. Overall survival rate, disease-free survival rate, positive surgical margin rate, positive lymph node rate, and seminal vesicle invasion rate were evaluated.
RESULTS AND CONCLUSION: Six randomized controlled trials totaling 1 027 participants were included. The result of meta analysis showed that there was no significant difference in overall survival rate [RR=0.94, 95%CI (0.86, 1.02)], disease-free survival rate [RR=1.02, 95%CI (0.89, 1.17)], positive lymph node rate [RR=0.86, 95%CI (0.47, 1.57)], and seminal vesicle invasion rate [RR=1.09, 95%CI (0.74, 1.59)] between single prostatectomy and preoperative hormone therapy plus prostatectomy, while there was significant difference in positive surgical margin rate [RR=0.46, 95%CI (0.32, 0.66)]. This suggested that preoperative hormonal therapy prior to prostatectomy did not improve survival rate, positive lymph nodes rate and seminal vesicle invasion rate; however, there was a significant reduction in the positive surgical margin rate.

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