Meta-analysis Of The Efficacy And Safety Of Abiraterone Acetate In The Treatment Of Castration-resistant Prostate Cancer

Objective:To systematically evaluate the therapeutic efficacy and safety of abiraterone acetate in the treatment of castration-resistant prostate cancer,in order to provide evidence-based basis for the rational use of abiraterone acetate in the treatment of patients with advanced prostate cancer in China.Methods:A computer search was conducted on CNKI database,Wanfang database,VIP database,Web of Science,Pub Med,Embase and Cochrane Library,and all randomized controlled trials on abiraterone acetate for castration-resistant prostate cancer published since the establishment of the database until December 31,2020.Two researchers strictly followed the inclusion and exclusion criteria established in this study.The Endnote X9 software was used for literature retrieval and cross-check after screening.If there was any objection,a third researcher was asked to discuss and decide.The final literature was evaluated for methodological quality using the Cochrane handbook bias risk assessment tool,the evaluation included whether random sequences were generated correctly,whether allocation concealment was implemented,whether blind methods were used,whether missing data were present,whether selective reporting was present,and whether other types of bias were present,each item was rated as "low risk of bias","high risk of bias" and "unclear",the evaluation results were cross-checked by two researchers and decided after discussion with a third researcher if necessary;Meta-analysis was performed on the data of the included literatures using Rev Man 5.3 software provided by the Cochrane Collaboration.Results:A total of 26 randomized controlled trials involving 8865 patients were included in this meta-analysis,including 4720 patients in the abirateron-treated group and 4145 patients in the non-abirateron-treated group.Meta-analysis results showed that: The median radiographic progression-free survival(MD=5.81,95%CI:3.58～8.03,P<0.01),PSA response rate(OR=2.77,95%CI:1.65 ～ 4.65,P<0.01),median overall survival(MD=6.44,95%CI:4.54～8.33,P<0.01),median time to PSA progression(MD=2.57,95%CI:1.30 ～ 3.84,P<0.01),median PSA progression-free survival(MD=6.74,95%CI:5.08 ～ 8.39,P<0.01),testosterone level control(MD=-0.41,95%CI:-0.68 ～-0.14,P<0.01),PSA level control(MD=-8.06,95%CI:-13.82～-2.31,P<0.01),effective rate(OR=2.94,95%CI:1.89 ～ 4.58,P<0.01),the number of patients with complete remission(OR=1.66,95%CI:1.02 ～ 2.72,P<0.05),residual urine volume control(MD=-4.56,95%CI:-6.94～-2.18,P<0.01),granulocytosis(OR=0.18,95%CI:0.07～0.45,P<0.01)and KPS score(MD=4.29,95%CI:4.06 ～ 4.52,P<0.01)were significantly better than those in non-abiraterone treatment group.The incidence of adverse reactions in hypertension(OR=2.04,95%CI:1.62 ～ 2.57,P<0.01),heart disease(OR=2.27,95%CI:1.80 ～ 2.86,P<0.01)and hypokalemia(OR=2.89,95%CI:1.59 ～5.26,P<0.01)were significantly higher than those in non-abiraterone group.The maximum urine flow rate(MD=-1.33,95%CI:-10.07～7.41,P>0.05),the number of drug discontinuance due to adverse reactions(OR=1.18,95%CI:0.93～1.49,P>0.05),fluid retention or edema(OR=1.23,95%CI:0.73 ～ 2.09,P>0.05),liver function impairment(OR=1.66,95%CI:0.93 ～ 2.97,P>0.05),fatigue and weakness(OR=0.87,95%CI:0.67 ～ 1.13,P>0.05),anemia(OR=0.86,95%CI:0.64 ～ 1.16,P>0.05)and elevated blood glucose(OR=1.51,95%CI:0.96～2.36,P>0.05)were no significant differences between the two groups.Conclusion:1.Abiraterone acetate can effectively delay the progression of castration-resistant prostate cancer,extend survival and improve quality of life in patients with castration-resistant prostate cancer,regardless of prior chemotherapy;2.Abiraterone acetate is not recommended for patients with cardiovascular and cerebrovascular diseases,and lower than normal levels of blood potassium due to various reasons.