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目的系统评价氯化锶治疗前列腺癌骨转移病灶的有效性和安全性。方法计算机检索Pub Med、The Cochrane Library、EMbase、VIP、CBM、CNKI和Wan Fang Data数据库,搜集氯化锶治疗前列腺癌骨转移病灶的随机对照试验(RCT),检索时限均为建库至2016年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入7个RCT,包括1 532例患者。Meta分析结果显示:与安慰剂比较,氯化锶的骨痛缓解率更高[RR=1.79,95%CI(1.35,2.37),P<0.000 1],但白细胞数量减少更多[Peto OR=5.02,95%CI(1.49,16.95),P=0.009]。两组在患者生存期方面,差异无统计学意义[RR=0.87,95%CI(0.58,1.30),P=0.49]。与放疗比较,氯化锶在骨痛缓解率更高[RR=1.28,95%CI(1.12,1.47),P=0.000 4],但在血小板数量减少方面差异无统计学意义[Peto OR=2.61,95%CI(1.04,6.57),P=0.04]。结论当前证据表明,氯化锶与安慰剂比较治疗前列腺癌骨转移病灶,在骨痛缓解率方面更优,但可引起轻度白细胞减少。氯化锶与放疗比较,在骨痛缓解率方面更优。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To evaluate the efficacy and safety of strontium chloride in the treatment of bone metastases from prostate cancer. Methods A randomized controlled trial (RCT) of strontium chloride in the treatment of bone metastases of prostate cancer was collected by computer searches of Pub Med, The Cochrane Library, EMbase, VIP, CBM, CNKI and Wan Fang Data. November. Two researchers independently screened the literature, extracted data, and assessed the risk of inclusion in the study. Meta-analysis was performed using Rev Man 5.3 software. Results A total of 7 RCTs were included, including 1 532 patients. Meta-analysis showed that compared with placebo, strontium chloride had a higher response to bone pain [RR = 1.79, 95% CI (1.35, 2.37), P <0.0001] 5.02, 95% CI (1.49, 16.95), P = 0.009]. There was no significant difference in survival between the two groups [RR = 0.87, 95% CI (0.58, 1.30), P = 0.49]. Compared with radiotherapy, strontium chloride had a higher remission rate in bone pain [RR = 1.28,95% CI (1.12,1.47), P = 0.0004], but there was no significant difference in platelet count [Peto OR = 2.61 , 95% CI (1.04, 6.57), P = 0.04]. CONCLUSIONS Current evidence indicates that strontium chloride compared with placebo in the treatment of bone metastases from prostate cancer is superior in relief of bone pain but may cause mild leukopenia. Strontium chloride compared with radiotherapy, bone pain relief rate is better. Due to the limited number and quality of studies included, the above conclusions have yet to be validated by more high-quality studies.