European urology oncology · 2025
Prostate Cancer Outcomes in Immunocompromised Patients: A Systematic Review and Meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Sanguedolce Francesco, Tedde Alessandro, Basile Giuseppe, Di Bello Francesco, Baboudjian Michael, Uleri Alessandro, Mancon Stefano, Chernysheva Daria, Roqué Figuls Marta, Gallioli Andrea, Territo Angelo, Rouprêt Morgan, Palou Joan, Breda Alberto
Аннотация
BACKGROUND AND OBJECTIVE: The role of immunosuppression in prostate cancer (PCa) mortality is a debated topic, with a low level of evidence. This review aims to evaluate the cancer-specific mortality (CSM) and overall mortality (OM) of PCa in immunocompromised patients compared with immunocompetent individuals.
METHODS: A literature search was conducted in the PubMed/Medline, Embase, and Web of Science databases (up to the March 31, 2024). The analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42022361504). Data were pooled using a fixed-effect model and adjusted hazard ratios (HRs).
KEY FINDINGS AND LIMITATIONS: A total of 13 studies (n ≈ 3.4 million PCa patients) were included in the qualitative analysis; 11 studies were included in the quantitative analysis. The forest plot for CSM in immunocompromised patients failed to reach statistical significance (HR 1.04 [95% confidence interval {CI}, 0.91-1.18], p = 0.57). OM was higher in the immunocompromised cohort (HR 2.04 [95% CI, 1.94-2.15], p < 0.001). CSM for transplanted patients was comparable with that for the controls (HR 1.01 [95% CI, 0.86-1.18], p = 0.94). Patients with human immunodeficiency virus (HIV) had higher CSM rates (HR 1.83 [95% CI, 1.21-2.75], p = 0.004). Limitations included retrospective cohort studies and heterogeneity in reporting PCa stages.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Transplanted patients present a CSM rate comparable with the controls, despite a higher OM rate. Other immunocompromised patients present an overall worse prognosis. The treatment algorithm should be applied by international guidelines for transplanted patients, delivering more aggressive treatments and screening strategies.
METHODS: A literature search was conducted in the PubMed/Medline, Embase, and Web of Science databases (up to the March 31, 2024). The analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42022361504). Data were pooled using a fixed-effect model and adjusted hazard ratios (HRs).
KEY FINDINGS AND LIMITATIONS: A total of 13 studies (n ≈ 3.4 million PCa patients) were included in the qualitative analysis; 11 studies were included in the quantitative analysis. The forest plot for CSM in immunocompromised patients failed to reach statistical significance (HR 1.04 [95% confidence interval {CI}, 0.91-1.18], p = 0.57). OM was higher in the immunocompromised cohort (HR 2.04 [95% CI, 1.94-2.15], p < 0.001). CSM for transplanted patients was comparable with that for the controls (HR 1.01 [95% CI, 0.86-1.18], p = 0.94). Patients with human immunodeficiency virus (HIV) had higher CSM rates (HR 1.83 [95% CI, 1.21-2.75], p = 0.004). Limitations included retrospective cohort studies and heterogeneity in reporting PCa stages.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Transplanted patients present a CSM rate comparable with the controls, despite a higher OM rate. Other immunocompromised patients present an overall worse prognosis. The treatment algorithm should be applied by international guidelines for transplanted patients, delivering more aggressive treatments and screening strategies.