The Impact of Neoadjuvant Hormone Therapy on Surgical and Oncological Outcomes for Patients With Prostate Cancer Before Radical Prostatectomy: A Systematic Review and Meta-Analysis

Abstract

Objective: This systematic study aimed to assess and compare the comprehensive evidence regarding the impact of neoadjuvant hormone therapy (NHT) on surgical and oncological outcomes of patients with prostate cancer (PCa) before radical prostatectomy (RP).

Methods: Literature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using PubMed, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang databases, we identified relevant studies published before July 2020. The pooled effect sizes were calculated in terms of the odds ratios (ORs)/standard mean differences (SMDs) with 95% confidence intervals (CIs) using the fixed or random-effects model.

Results: We identified 22 clinical trials (6 randomized and 16 cohort) including 20,199 patients with PCa. Our meta-analysis showed no significant differences in body mass index (SMD = 0.10, 95% CI: -0.08-0.29, p = 0.274) and biopsy Gleason score (GS) (OR = 1.33, 95% CI: 0.76-2.35 p = 0.321) between the two groups. However, the NHT group had a higher mean age (SMD = 0.19, 95% CI: 0.07-0.31, p = 0.001), preoperative prostate-specific antigen (OR = 0.47, 95% CI: 0.19-0.75, p = 0.001), and clinic tumor stage (OR = 2.24, 95% CI: 1.53-3.29, p < 0.001). Compared to the RP group, the NHT group had lower positive surgical margins (PSMs) rate (OR = 0.44, 95% CI: 0.29-0.67, p < 0.001) and biochemical recurrence (BCR) rate (OR = 0.47, 95% CI: 0.26-0.83, p = 0.009). Between both groups, there were no significant differences in estimated blood loss (SMD = -0.06, 95% CI: -0.24-0.13, p = 0.556), operation time (SMD = 0.20, 95% CI: -0.12-0.51, p = 0.219), pathological tumor stage (OR = 0.76, 95% CI: 0.54-1.06, p = 0.104), specimen GS (OR = 0.91, 95% CI: 0.49-1.68, p = 0.756), and lymph node involvement (OR = 0.76, 95% CI: 0.40-1.45, p = 0.404).

Conclusions: NHT prior to RP appeared to reduce the tumor stage, PSMs rate, and risk of BCR in patients with PCa. According to our data, NHT may be more suitable for older patients with higher tumor stage. Besides, NHT may not increase the surgical difficulty of RP.

Keywords: clinical research; meta-analysis; neoadjuvant hormone therapy; prostate cancer; radical prostatectomy.

Figure 1

The flowchart of this meta-analysis in accordance with PRISMA guidelines.

Figure 2

Forest plot of pooled hazard ratios for perioperative variables: (A) BMI; (B) biopsy GS. No significant differences between the NHT and RP groups were found.

Figure 3

Forest plot of pooled hazard ratios for perioperative variables, NHT group had a higher: (A) advanced age; (B) p-PSA; (C) clinic tumor stage than RP group.

Figure 4

Forest plot of pooled hazard ratios for postoperative variables: (A) EBL; (B) OT; (C) pathological tumor stage; (D) LNI; (E) specimen GS. No significant differences between the NHT and RP groups were found.

Figure 5

Forest plot of pooled hazard ratios for postoperative variables, NHT group had a lower (A) PSMs; (B) BCR than RP group.

Figure 6

Funnel plots to explore publication bias in the estimates of perioperative variables: (A) advanced age; (B) p-PSA; (C) clinic tumor stage. No significant publication bias was found.

Figure 7

Funnel plots to explore publication bias in the estimates of postoperative variables: (A) EBL; (B) OT; (C) PSMs; (D) BCR; (E) pathological tumor stage; (F) specimen GS; (G) LNI. No significant publication bias was found.