CAJ | 학술논문

背景:研究已证实术前激素治疗减低了前列腺癌患者的临床分期和病理分期,减少了切缘阳性率,但是并没有提高患者的无病生存率.目前术前激素治疗前列腺癌的价值尚无定论.目的:评价术前激素治疗在治疗局限性前列腺癌中的作用.方法:计算机检索PubMed、EMBASE、Cochrane Library(2009年第4期)、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库中2009年10月前发表的文章,手工检索相关领域的杂志.纳入随机对照试验,经病理学及细胞学检查确诊为局限性前列腺癌的患者,性别和民族不限,没有严重的心肺疾病;排除晚期或是复发的前列腺癌患者.同时从纳入文献的参考文献中查找符合要求的随机对照试验.采用国际Cochrane协作组提供的Revman 5.0软件进行统计分析.主要评价无病生存率、切缘阳性率、淋巴结阳性率、精囊浸润率4个结局指标.结果与结论:共纳入6篇随机对照试验合计1 027人,meta分析结果显示:与单纯的前列腺癌手术相比,术前激素治疗联合前列腺癌手术在无病生存率[RR=I.02,95%CI(0.89,1.17)],淋巴结阳性率[RR=0.86,95%CI(0.47,1.57)]、精囊浸润率[RR=1.09,95%CI(0.74,1.59)]方面差异无显著性意义,而在手术切缘阳性率[RR=0.46,95%CI(0.32,0.66)]方面差异有显著性意义.提示术前激素治疗联合前列腺癌根治术能减低局限性前列腺癌患者的手术切缘阳性率,但是并不能提高患者的无病生存率、淋巴结阳性率、精囊浸润率.
배경:연구이증실술전격소치료감저료전렬선암환자적림상분기화병리분기,감소료절연양성솔,단시병몰유제고환자적무병생존솔.목전술전격소치료전렬선암적개치상무정론.목적:평개술전격소치료재치료국한성전렬선암중적작용.방법:계산궤검색PubMed、EMBASE、Cochrane Library(2009년제4기)、중국생물의학문헌수거고、중국기간전문수거고、유보중문과기기간수거고중2009년10월전발표적문장,수공검색상관영역적잡지.납입수궤대조시험,경병이학급세포학검사학진위국한성전렬선암적환자,성별화민족불한,몰유엄중적심폐질병;배제만기혹시복발적전렬선암환자.동시종납입문헌적삼고문헌중사조부합요구적수궤대조시험.채용국제Cochrane협작조제공적Revman 5.0연건진행통계분석.주요평개무병생존솔、절연양성솔、림파결양성솔、정낭침윤솔4개결국지표.결과여결론:공납입6편수궤대조시험합계1 027인,meta분석결과현시:여단순적전렬선암수술상비,술전격소치료연합전렬선암수술재무병생존솔[RR=I.02,95%CI(0.89,1.17)],림파결양성솔[RR=0.86,95%CI(0.47,1.57)]、정낭침윤솔[RR=1.09,95%CI(0.74,1.59)]방면차이무현저성의의,이재수술절연양성솔[RR=0.46,95%CI(0.32,0.66)]방면차이유현저성의의.제시술전격소치료연합전렬선암근치술능감저국한성전렬선암환자적수술절연양성솔,단시병불능제고환자적무병생존솔、림파결양성솔、정낭침윤솔.
BACKGROUND:Previous research has demonstrated that preoperative hormone therapy relieved clinicaI and pathological stages of prostatic carcinoma patients,reduced positive ratio of incisaI margin:however,it did not increase disease-free surviva J rate.Worth of preoperative hormone therapy for prostatic carcinoma remains unclear.OBJECTIVE:To assess the role of preoperative hormone therapy in localised prostate cancer.METHODS:Articles were searched from PubMed,Embase.Cochrane Library(No.4,2009),Chinese biomedicaf literature database,Chinese Scientific Journals full_text database,and Chinese Journal full-text database(published before October,2009).Randomized controlled trials which were diagnosed as Iocalised prostate cancer using pathology and cytology were included The sex and nationality were not limited.and patients did not have severe heart and lung diseases Prostatic carcinoma which occurred Later or repeatedly was excluded.Otherwise.randomized controlled trails which were coincidence with the inclusion criteria were also included.Review Manager 5.0 published by Cochrane was used for stafistical analysis.Overall survival rate.disease-free survivaI rate,positive surgical margin rate,positive lymph node rate.and seminal vesicle invasion rate were evaluated.RESULTS AND CONCLUSlON:Six randomized controlled trials totaling 1 027 padicipants were included.The result of meta analysis showed that there was no significant difference in overall surviva J rate[RR=0.94,95%C,(0.86,1.02)],disease-free survival rate[RR=1.02,95%CI(0.89,1.17)],positive lymph node rate IRR=0.86,95%CI(0.47,1.57)],and seminal vesicle invasion rate[RR=1.09,95%CI(0.74,1.59)]between single prostatectomy and preoperative hormone therapy plus prostatectomy,while there was significant difference in positive surgical margin rate[RR=0.46,95%CI(0.32,0.66)]This suggested that preoperative hormonal therapy prior to prostatectomy did not improve survival rate,positive lymph nodes rate and seminaI vesicle invasion rate:however.there was a significant reduction in the positive surgicaI margin rate.