|
Objective To evaluate the efficacy of brachytherapy for localized prostate cancer, postoperative complications, quality of life and cost. Through PubMed, EMBASE, Ovid and Cochrane Library databases and manual searches of the collection has been published at home and abroad for localized prostate cancer brachytherapy (BT) with radical prostatectomy surgery (RP) contrast a randomized controlled trial (RCT) and prospective, observational, controlled study English literature filter by default inclusion and exclusion criteria, and evaluate the quality of the included RCT. Extract the 5-year biochemical recurrence-free survival as an endpoint to evaluate long-term efficacy of BT; extract the EPIC questionnaire Scale 5 to evaluate BT complications and health-related quality of life (HRQOL), they are: urinary irritation or obstruction index score, urinary incontinence index score, urinary tract function index score, bowel function index score, Sexual Function Index score; extract the total cost of treatment evaluation of BT's economic problems. And a simple analysis of whether there is publication bias. Meta-analysis of the statistical analysis by the Cochrane Collaboration recommended professional system evaluation software RevMan 4.2 is complete. Results by screening, the final survival rate indicators, five RCTs the Jadad score line quality evaluation, the methodological quality of the included RCT were higher, after a total of 4445 cases of patients in the combined sample size, BT group (test group) 2146 RP group (control group) 2299 cases, analysis results show that the two kinds of treatment of 5-year biochemical recurrence-free survival pooled OR value of the difference was not statistically significant (OR value of 1.08, 95% CI 0.70 ~ 1.67, P = 0.72 gt; 0.05), BT's long-term cancer control rate of RP. 3 postoperative complications and HRQOL, are well-designed prospective, observational, controlled study. The results showed that: ① BT group compared with the RP group, a higher incidence of postoperative urinary tract irritation and urinary tract obstruction, more severe (WMD = -4.36,95% CI -8.14 to -0.58, P = 0.02 lt; 0.05), poor postoperative bowel function (WMD = -2.73,95% CI -4.31 to -1.15, P = 0.0007 lt; 0.05). ② BT group compared with the RP group, the incidence and severity of postoperative incontinence lighter (WMD = 11.10,95% CI 8.20 to 14.00, P lt; 0.00001), the comprehensive evaluation of urinary tract function better (WMD = 5.31, 95% CI, 2.91 to 7.71, P lt; 0.0001), by treatment affect sexual function RP (WMD = 16.17,95% CI for 12.97 to 19.36, P lt; 0.00001). Indicators about the cost of treatment was not found in the literature that met the inclusion criteria, Meta-analysis can not be carried out. Publication bias analysis confirmed that the Meta-analysis results are reliable. Concluding prostate cancer BT long-term efficacy of the treatment with RP was no significant difference. BT compared to RP, a lesser incidence and severity of the patients with urinary incontinence, comprehensive evaluation urinary tract function better by treatment affect sexual function than RP patients BT postoperative urinary tract irritation and urinary tract obstruction a higher incidence of more severe bowel function RP differential. Recommended that in the future engage in more large multicenter RCT re-incorporated into the new RCT published to further enhance the Meta-analysis of the reliability of the evidence.
|