Abstract
BackgroundsAt present, the application of tumor reduction surgery in oligometastatic prostate cancer has aroused extensive discussion among urologists, but clinicians have not reached a consensus on this issue. The purpose of this study was to evaluate the effect of cytoreductive surgery for patients with oligometastatic prostate cancer by meta-analysis.MethodsAll relevant studies were systematically searched through The Cochrane Library, PubMed, Web of Science, EMBASE, and China Biomedical Literature Database (CBM) up to December 2019. All the previous clinical studies on the comparison of long-term efficacy between the cytoreductive surgery group and the endocrine therapy group were included in the search. The included studies were analyzed using Stata ver.14.0. The research has been registered on PROSPERO website with the registration number of crd42021224316. The relevant registration information can be obtained from the website: https://www.crd.york.ac.uk/prospero.ResultsThe case presentation is as follows: ten studies were identified that met the conclusion criteria. The total number of samples was 804; 449 patients underwent cytoreductive surgery, and 355 patients underwent endocrine therapy, and we conducted 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, a significant difference existed in overall survival (HR = 0.635, 95% CI 0.443–0.908, P = 0.013), cancer-specific survival (HR = 0.407, 95% CI 0.243–0.681, P = 0.001), and progression-free survival (HR = 0.489, 95% CI 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).ConclusionThe 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.
Highlights
The concept of oligometastases was firstly proposed by Professor Hellman and Weichselbaum [1] in 1995
Cheng et al World Journal of Surgical Oncology (2021) 19:160 experts identified a limited number of bone and/or lymph nodes as clinically oligometastatic prostate cancer; 10% of the experts believe that oligometastatic prostate cancer is include only limited lymph node metastases; 13% of the experts were more radical, believing that oligometastatic prostate cancer could be limited in number of metastases, including lymph nodes, bone, and viscera
These results indicate that patients with metastatic prostate cancer can benefit from survival through tumor reduction surgery
Summary
The concept of oligometastases was firstly proposed by Professor Hellman and Weichselbaum [1] in 1995. They defined it as a clinical stage between the simple localized state and the extensive metastasis state, that is, the oligometastasis. Ten percent of the experts did not believe there was a clinical stage of oligometastasis. Singh et al [3] analyzed patients with oligometastatic prostate cancer treated with external radiotherapy by retrospective analysis and found that patients with < or = 5 metastatic sites had significantly better survival rates than patients with > 5 lesions. The present accepted definition of oligometastatic prostate cancer is that there are less than or equal to 5 bone metastases, with or without local lymph node metastases, but no visceral metastases [4]
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