Introduction and Aims: Androgen deprivation therapy (ADT) with systemic anti-cancer treatment (SACT) ± palliative radiotherapy (pRT) is the current standard of care for Oligo-metastatic hormone-sensitive prostate cancer (o-mHSPC). Cytoreductive radical prostatectomy (cRP) has gained interest in this group of patients, with potential benefits including reduced tumour burden and a lower risk of local events from disease progression. In this review, we compare both survival outcomes and local event rates between cRP and upfront ADT ± SACT. Methods: All randomised trials and observational studies comparing cRP with standard treatment (ST), which we defined as ADT ± SACT for o-mHSPC, were included in the review. The study protocol was registered in PROSPERO (CRD42024516586), and the review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases searched included Embase, Medline, Cochrane Library, PubMed, and Web of Science. A risk of bias assessment was performed for the included studies as recommended by the Cochrane Handbook of Systematic Reviews and Interventions. The primary outcome measures were Overall Survival (OS), Cancer-Specific Survival (CSS), Progression-free Survival (PFS), Castrate-resistant Prostate Cancer-free Survival (CRPC-FS), and local complication rates. The secondary outcome measures were complication rates and functional outcomes post-cRP. Results: A total of 5130 studies were identified for this review (5119 by database searching and 11 through manual searching). Eight studies were included in the review, comprising 611 patients. cRP was identified to have superior OS (HR: 0.56 (95% CI: 0.34–0.92), I2= 0%,p= 0.02 (very low certainty)) and CSS (HR: 0.27 (95% CI: 0.15–0.47), I2= 0%,p< 0.0001 (very low certainty)). The PFS (HR: 0.67 (95% CI: 0.34–1.33), I2= 58%,p= 0.25 (very low certainty)) and CRPC-FS (HR: 0.67 (95% CI: 0.32–1.43), I2= 57%,p= 0.30 (very low certainty)) were similar between the two groups. The rates of local events were significantly lower in patients undergoing cRP (RR 0.27 (95% CI: 0.13–0.59), I2= 17%,p= 0.001 (low certainty)). The rates of Clavien–Dindo (CD) grade 3 or higher complications ranged from 0% to 13.1%. Additionally, the reported continence rates ranged from 81.5% to 91.3%. The review is limited by the lack of a uniform definition for o-mHSPC and the predominance of low-quality, heterogeneous studies. Despite mitigation strategies, the overall certainty of evidence remains very low per GRADE assessment. Conclusion: cRP significantly reduces local event rates compared with ST and offers comparable PFS and CFPC-FS, with superior OS and CSS in the cRP arm compared to the ST arm in patients with o-mHSPC. However, there is a paucity of high-quality literature on this subject. Ongoing randomised controlled trials may soon clarify the role of cRP in the context of o-mHSPC concerning survival benefits.
引言与目的：对于寡转移性激素敏感性前列腺癌（o-mHSPC），目前的标准治疗方案是雄激素剥夺疗法（ADT）联合全身性抗癌治疗（SACT）±姑息性放疗（pRT）。减瘤性根治性前列腺切除术（cRP）在该患者群体中日益受到关注，其潜在益处包括减轻肿瘤负荷和降低疾病进展导致的局部事件风险。本综述比较了cRP与先行ADT ± SACT在生存结局和局部事件发生率方面的差异。 方法：本综述纳入了所有比较cRP与标准治疗（ST）的随机试验和观察性研究，其中ST定义为针对o-mHSPC的ADT ± SACT。研究方案已在PROSPERO注册（CRD42024516586），综述过程遵循系统综述和荟萃分析优先报告条目（PRISMA）指南。检索的数据库包括Embase、Medline、Cochrane Library、PubMed和Web of Science。根据Cochrane系统综述和干预手册的建议，对纳入的研究进行了偏倚风险评估。主要结局指标包括总生存期（OS）、癌症特异性生存期（CSS）、无进展生存期（PFS）、去势抵抗性前列腺癌无生存期（CRPC-FS）以及局部并发症发生率。次要结局指标为cRP术后并发症发生率和功能结局。 结果：本次综述共识别出5130项研究（通过数据库检索5119项，手动检索11项）。最终纳入8项研究，共涉及611名患者。分析发现，cRP在OS（HR: 0.56 (95% CI: 0.34–0.92), I²= 0%, p= 0.02（证据确定性极低））和CSS（HR: 0.27 (95% CI: 0.15–0.47), I²= 0%, p< 0.0001（证据确定性极低））方面更具优势。两组的PFS（HR: 0.67 (95% CI: 0.34–1.33), I²= 58%, p= 0.25（证据确定性极低））和CRPC-FS（HR: 0.67 (95% CI: 0.32–1.43), I²= 57%, p= 0.30（证据确定性极低））相似。接受cRP治疗的患者局部事件发生率显著更低（RR 0.27 (95% CI: 0.13–0.59), I²= 17%, p= 0.001（证据确定性低））。Clavien-Dindo（CD）3级或以上并发症的发生率在0%至13.1%之间。此外，报告的控尿率在81.5%至91.3%之间。本综述的局限性在于缺乏对o-mHSPC的统一定义，且纳入的研究多为低质量、异质性研究。尽管采取了缓解策略，根据GRADE评估，证据的整体确定性仍然极低。 结论：与ST相比，cRP能显著降低o-mHSPC患者的局部事件发生率，并提供可比的PFS和CRPC-FS；同时，cRP组在OS和CSS方面优于ST组。然而，关于该主题的高质量文献仍然匮乏。正在进行的随机对照试验可能很快会阐明cRP在o-mHSPC治疗中关于生存获益的作用。
肿瘤(癌症)患者之家