预防前列腺癌患者的疾病进展的非手术干预措施在积极监测下:系统审查和元分析
Akihiro Matsukawa1, Takafumi Yanagisawa1, Kensuke Bekku2
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
European urology oncology
|January 26, 2024
概括
5α减少酶抑制剂 (5-ARI) 有助于减缓前列腺癌在积极监测中的患者的进展,提供更长的无进展生存期,副作用最小. 对其他干预措施的证据仍然有限,需要进一步研究.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 药理学 药理学是指药理学的学科.
背景情况:
- 积极监测 (AS) 是低风险和选择的中等风险前列腺癌 (PCa) 的标准管理策略.
- 关于在AS期间有效管理疾病轨迹的干预措施的证据有限.
- 评估预防AS期间PCa进展的干预措施对于优化患者结果至关重要.
研究的目的:
- 在积极监测期间,系统地评估有效预防前列腺癌进展的干预措施.
- 评估各种治疗剂和生活方式改变对AS患者PCa疾病轨迹的影响.
主要方法:
- 在PubMed,Scopus和Web of Science数据库中进行了系统的文献搜索.
- 包括检查干预措施减缓AS期间PCa进展的研究.
- 主要终点是PCa进展 (包括病理升级);次要终点是治疗毒性.
主要成果:
- 22项研究 (6项RCT,16项观察性) 分析了包括5α减少酶抑制剂 (5-ARI),他类药物,饮食,运动等在内的干预措施.
- 5-ARI与改善无进展生存 (PFS) (HR:0.59;95% CI:0.48-0.72) 显著相关,但毒性没有增加.
- 其他干预措施,如维生素D3,马丁,fexapotide triflutate和恩扎胺,显示出一些疗效,但与显著的不良事件 (高达88%) 有关.
结论:
- 5α减少酶抑制剂 (5-ARI) 与正在接受积极监测的前列腺癌患者的更长的PFS有关.
- 目前对其他干预措施的证据很弱,因此很难就其有效性和安全性得出明确的结论.
- 需要进一步的研究,以确定男性AS的替代干预措施的有效性和安全性.
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