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Meta-Analysis
. 2017 Jul-Aug;43(4):588-599.
doi: 10.1590/S1677-5538.IBJU.2016.0483.

Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Arie Carneiro  1   2 , Willy Baccaglini  2 , Felipe P A Glina  3 , Paulo P Kayano  1 , Victor M Nunes  4 , Oren Smaletz  5 , Wanderley Marques Bernardo  4 , Icaro Thiago de Carvalho  6 , Gustavo Caserta Lemos  1
Affiliations
Meta-Analysis

Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Arie Carneiro et al. Int Braz J Urol. 2017 Jul-Aug.

Abstract

Context: Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors.

Objective: To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa.

Materials and methods: Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT).

Results: 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I²=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I²=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I²=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I²=67%) presented better outcomes.

Conclusion: LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

Keywords: Prostate; Prostatic Neoplasms; Radiation Oncology; Survival.

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Conflict of interest statement

CONFLICT OF INTEREST

None declared.

Figures

Figure 1
Figure 1. Studies Selection.
Figure 2
Figure 2. (A) Forest Plot - overall survival in 3 years of patients submitted to LT in relation to those treated with NLT with or without; (B) Forest Plot - sub-analysis of overall survival in 3 years of patients submitted to LT in relation to those treated with NLT with ADT; (C) Forest Plot - overall survival in 5 years of patients submitted to LT in relation to those treated with NLT.
Figure 3
Figure 3. Forest Plot - cancer-specific survival in 5 years of patients submitted to LT in relation to those treated with NLT.
Figure 4
Figure 4. (A) Forest Plot - overall survival in 3 years of patients submitted to LT with RP in relation to NLT group; (B) Forest Plot - cancer-specific survival in 3 years of patients submitted to LT and RP in relation to NLT group.
Figure 5
Figure 5. (A) Forest Plot - cancer-specific survival after 3 years of patients submitted to LT and RP in relation to NLT group; (B) Funnel Plot - analysis of sensitivity of cancer-specific survival after 3 years of patients submitted to LT and RP in relation to NLT group; (C) Forest Plot - analysis of sensitivity of cancer-specific survival after 3 years of patients submitted to LT and RP in relation to NLT group.
Figure 6
Figure 6. (A) Forest Plot - overall survival in 3 years of patients submitted to LT with RDT or BQT in relation to NLT group with or without ADT; (B) Forest Plot - sub-analysis of overall survival in 3 years of patients submitted to LT in relation to those treated with NLT and ADT; (C) Forest Plot - sub-analysis of cancer-specific survival after 3 years of patients submitted to LT with RDT or BQT in relation to those treated with NLT.
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