European urology focus · 2025
Impact of Metastatic Hormone-sensitive Prostate Cancer Treatments on Health-related Quality of Life: A Systematic Review and Network Meta-analysis.
Систематический обзорNetwork Meta-AnalysisСтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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van Elst Tessa, Lopez Pedro, Buffart Laurien M, Custers Jose A E, Wever Lieke, de Bie Jippe C, Mulders Peter F A, Bloemendal Haiko J, van Basten Jean-Paul A, Mehra Niven
Аннотация
BACKGROUND AND OBJECTIVE: In metastatic hormone-sensitive prostate cancer (mHSPC), health-related quality of life (HRQoL) is key for personalised treatment decisions. We compared the impact of different mHSPC treatment strategies on HRQoL, tackling a previously unaddressed challenge in comparing the outcomes across different patient-reported outcome measures (PROMs).
METHODS: A systematic review was conducted of prospective studies reporting HRQoL outcomes of androgen deprivation therapy (ADT) alone or with placebo, radiotherapy, abiraterone, apalutamide, enzalutamide, and/or docetaxel in mHSPC (CRD42021227902). Databases were searched in April 2022 and April 2024. HRQoL domains across different PROMs were harmonised using the Wilson and Cleary model. A frequentist network meta-analysis (NMA) compared 12-mo treatment effects using standardised mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05.
KEY FINDINGS AND LIMITATIONS: Of the 24 articles included, nine were analysed in the NMA (eight trials, n = 6248). ADT + abiraterone resulted in significantly less pain than ADT + placebo (SMD: -0.22, 95% CI [-0.33; -0.10], p < 0.001), ADT + apalutamide (SMD: -0.17, 95% CI [-0.31; -0.02], p = 0.022), and ADT + enzalutamide (SMD: -0.23, 95% CI [-0.37; -0.09], p = 0.001). Less fatigue was observed with ADT + abiraterone versus ADT + enzalutamide (SMD: -0.45, 95% CI [-0.88; -0.02], p = 0.041). ADT + abiraterone showed significantly better physical functioning than ADT + enzalutamide (p = 0.015) and ADT + placebo (p = 0.032). Both were also associated with significantly worse general health perception than ADT alone, ADT + docetaxel, and ADT + radiotherapy. General health perception and overall quality of life were significantly better with ADT + abiraterone than with ADT + enzalutamide, ADT + apalutamide, and ADT + placebo (p < 0.001). The limitations include heterogeneity (0-76%) and few eligible trials.
CONCLUSIONS AND CLINICAL IMPLICATIONS: HRQoL outcomes differ across treatment strategies for mHSPC. At 12 mo, ADT + abiraterone yielded the most favourable HRQoL profile.
METHODS: A systematic review was conducted of prospective studies reporting HRQoL outcomes of androgen deprivation therapy (ADT) alone or with placebo, radiotherapy, abiraterone, apalutamide, enzalutamide, and/or docetaxel in mHSPC (CRD42021227902). Databases were searched in April 2022 and April 2024. HRQoL domains across different PROMs were harmonised using the Wilson and Cleary model. A frequentist network meta-analysis (NMA) compared 12-mo treatment effects using standardised mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05.
KEY FINDINGS AND LIMITATIONS: Of the 24 articles included, nine were analysed in the NMA (eight trials, n = 6248). ADT + abiraterone resulted in significantly less pain than ADT + placebo (SMD: -0.22, 95% CI [-0.33; -0.10], p < 0.001), ADT + apalutamide (SMD: -0.17, 95% CI [-0.31; -0.02], p = 0.022), and ADT + enzalutamide (SMD: -0.23, 95% CI [-0.37; -0.09], p = 0.001). Less fatigue was observed with ADT + abiraterone versus ADT + enzalutamide (SMD: -0.45, 95% CI [-0.88; -0.02], p = 0.041). ADT + abiraterone showed significantly better physical functioning than ADT + enzalutamide (p = 0.015) and ADT + placebo (p = 0.032). Both were also associated with significantly worse general health perception than ADT alone, ADT + docetaxel, and ADT + radiotherapy. General health perception and overall quality of life were significantly better with ADT + abiraterone than with ADT + enzalutamide, ADT + apalutamide, and ADT + placebo (p < 0.001). The limitations include heterogeneity (0-76%) and few eligible trials.
CONCLUSIONS AND CLINICAL IMPLICATIONS: HRQoL outcomes differ across treatment strategies for mHSPC. At 12 mo, ADT + abiraterone yielded the most favourable HRQoL profile.