Efficacy Of Cytoreductive Surgery For Oligometastatic Prostate Cancer:a Meta-analysis

Background:Prostate cancer is one of the most common malignant tumors in man,occupying second place for male knobbly,according to the global cancer incidence statistics.Thus so far,radical prostatectomy remains the most significant method in the treatment of prostate cancer,but the surgical treatment is mainly for those patients in the initial stage.Unfortunately,it often loss the best operation opportunity to treat because of the condition is insidious.In recent years,the concept of Oligometastatic prostate cancer was brought forward,which gives us a hope to treatment for patients with tumors that were previously deemed at a late stage or even distant metastasis.Oligometastatic prostate cancer may be a special stage of prostate cancer progression.Positive treatment of oligometastatic prostate cancer may achieve good results,such as cytoreductive surgery.Therefore,research on cytoreductive surgery has become the discussed hotspot in the area of oligometastatic prostate cancer,and it has not reached a consensus yet.Objective:The purpose of this study was to conduct a meta-analysis of studies to compare the long-term treatment effectiveness of endocrine therapy and cytoreductive surgery for treating prostate cancer.Methods:A systematic literature search of articles that comparing cytoreductive surgery with endocrine therapy before August 15th 2018 was conducted via PubMed,Web of science,EMBASE,Cochrane Library and CBM,at the same time,collection and analysis the relative literatures.According to the inclusion and exclusion criteria,two researchers screen all the articles independently and choose the appropriate articles.Then assess the quality of them and extract the related data,finally,use Stata SE 12.0 software to analyze all the outcomes including overall survival,cancer specific survival,progression-free survival,progresses to castration-resistant prostate cancer.Results:Ten studies were identified that met the conclusion criteria.Within these studies,The total number of samples was 804,449 patients underwent cytoreductive surgery,and 355 patients underwent endocrine therapy,and conducting a meta-analysis of studies to compare the prognosis of endocrine therapy and cytoreductive surgery for treating prostate cancer.After all the studies were analyzed,we found that between cytoreductive surgery and endocrine therapy,significant difference existed in overall survival(HR=0.635,95CI:0.443-0.908,P=0.013),cancer specific survival(HR=0.407,95CI:0.243-0.681,P=0.001),and progression-free survival(HR=0.489,95CI:0.315-0.758,P=0.001).While there were no significant difference in Progresses to castration-resistant prostate cancer(HR=0.859,95%CI:0.475-1.554,P=0.616).Conclusion:The cytoreductive surgery held advantages in overall survival,cancer specific survival and progression-free survival.Therefore,compared with endocrine therapy,cytoreductive surgery could be a more suitable approach in treating oligometastatic prostate cancer.More random clinical trials that are large-sample and followed up longly are needed in the future to assess these two approaches.