A Meta-analysis Of The Prognostic Effects Of Endocrine Combined With External Beam Radiotherapy And Endocrine Alone On Locally Advanced Prostate Cancer

Objective:To compare the efficacy of endocrine combined with external beam radiotherapy and endocrine alone in the treatment of locally advanced prostate cancer by meta-analysis.Methods:We searched PubMed,Medine,The Cochrane Library,Wliey,Ovid,EMbase,Springerlink,EBSCO,Baidu Scholar,VIP,CNKI,Wanfang Database by computer.To search the relevant RCT literatures published at home and abroad before January 2019 on patients with locally advanced prostate cancer treated with endocrine alone or combined with external beam radiotherapy.According to the inclusion and exclusion criteria,the literature was screened,there are two researchers performing screening,bias risk assessment,quality assessment and data extraction independently.Provided that any discrepancy involved in the result,the resolution will concluded through discussion or consultation by a third researcher.And Review Manager 5.3 version will be adopted for Meta analysis.The outcome measures included overall survival?prostate cancer-specific mortality?distant metastases?time to progression?biochemical failure?disease-specific mortality.Results:In this meta-analysis,a total of 4 RCT studies were included,including a total of 2533 patients with locally advanced prostate,including 1262 patients in the endocrine therapy group alone and 1271 patients in the endocrine combine with external beam radiotherapy group.The study found that endocrine combine with external radiotherapy group had better prognosis and efficacy in overall sur vival(HR=1.39,95%CI:1.22-1.58,P<0.001),prostate cancer-specific mortality(HR=0.43,95%CI:0.35-0.53,<0.001),time to progression(HR=3.00,95%CI:2.47-3.64,P<0.001),biochemical failure(OR=0.14,95%CI:0.08-0.23,P<0.001)and disease-s pecific mortality(OR=0.48,95%CI:0.39-0.60,P<0.001)compared with endocrine therapy group,and the difference was statistically significant.Distant metastases(HR=1.78,95%CI:0.30-10.54,P=0.52)showed no statistical significance-Conclusion:Both methods are effective in the treatment of locally advanced pro?state cancer,but endocrine combined with external beam radiotherapy is better th an endocrine alone in overall survival,prostate cancer-specific mortality,time to progression,biochemical failure and disease-specific mortality,It is beneficial to the survival of patients.The difference between the two approaches on distant metastases is not significant and has no statistical significance.Given that there i5 a small number of results probably existing bias on the basis of included studies,it is expected to include more large-scale prospective randomized studies to verify the conclusions in the future.