4.3 Article

Network meta-analysis of the efficacy and adverse effects of several treatments for advanced/metastatic prostate cancer

Journal

ONCOTARGET
Volume 8, Issue 35, Pages 59709-59719

Publisher

IMPACT JOURNALS LLC
DOI: 10.18632/oncotarget.19810

Keywords

prostate cancer; endocrine therapy; efficacy; adverse effects; randomized controlled trials

Funding

  1. Yunnan Provincial Science and Technology Department [2014FB003]
  2. Lower Urinary Tract and Pelvic Floor Dysfunction Innovation Team of Kunming Medical University [CXTD201618]
  3. Medical Discipline Leaders of Health and Family Planning Commission of Yunnan Province [D-201615]

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This network meta-analysis was conducted to compare the efficacy and adverse effects of several treatments for advanced/metastatic prostate cancer (PC). The PubMed and Cochrane Library databases were searched for randomized controlled trials of treatments for advanced/metastatic PC. Eighteen studies covering 6,340 patients were included in this analysis. The calculated were odds ratios, 95% confidence intervals, and the surface under the cumulative ranking (SUCRA) curve. Pairwise meta-analysis showed that overall survival rates achieved with radiotherapy or endocrine therapy were lower than obtained with radiotherapy + endocrine therapy. The endocrine therapy includes estrogen therapy, luteinizing hormone-releasing hormone agonist (LHRH-A), anti-androgen therapy (ADT), ADT + LHRH-A and estrogen therapy + LHRH-A, and its SUCRA values indicated that for overall response rate, estrogen therapy + LHRH-A ranked the highest (92.6%); for overall survival rate, ADT ranked the highest (75.2%); for anemia, estrogen therapy ranked the highest (88.2%); and for diarrhea and hot flushes, ADT ranked the highest (diarrhea, 87.4%; hot flushes, 89.3%). Cluster analysis on the endocrine therapy showed that ADT + LHRH-A achieved the highest overall survival and overall response rates in the treatment of advanced/metastatic PC. Estrogen therapy and ADT had the lowest incidences of diarrhea and anemia. Thus, combined radiotherapy + endocrine therapy had higher overall survival rate, and among the endocrine therapy, in terms of overall response rate and overall survival rate, ADT + LHRH-A may be a better regimen in the treatment of advanced or metastatic PC.

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