Objective To systematically review the efficacy and safety of abiraterone acetate in the treatment of castration-resistant prostate cancer. Methods CNKI, WanFang Data, VIP, Web of Science, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials on abiraterone in the treatment of castration-resistant prostate cancer from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 25 randomized controlled trials involving 8 654 patients were included. Meta-analysis results showed that the median radiographic progression-free survival (MD=5.81, 95%CI 3.58 to 8.03, P<0.01), PSA response rate (RR=2.77, 95%CI 1.65 to 4.65, P<0.01), median overall survival (MD=6.44, 95%CI 4.54 to 8.33, P<0.01), median time to PSA progression (MD=2.57, 95%CI 1.30 to 3.84, P<0.01), median PSA progressionfree survival (MD=6.74, 95%CI 5.08 to 8.39, P<0.01), testosterone level control (MD=−0.41, 95%CI −0.68 to −0.14, P<0.01), PSA level control (MD=−8.06, 95%CI −13.82 to −2.31, P<0.01), effective rate (RR=2.94, 95%CI 1.89 to 4.58, P<0.01), complete remission (RR=1.66, 95%CI 1.02 to 2.72, P<0.05), granulocytopenia (RR=0.18, 95%CI 0.07 to 0.45, P<0.01) and KPS score (MD=4.29, 95%CI 4.06 to 4.52, P<0.01) were significantly superior to non-abiraterone treatment group. The incidence of hypertension (RR=2.04, 95%CI 1.62 to 2.57, P<0.01), heart disease (RR=2.27, 95%CI 1.80 to 2.86, P<0.01) and hypokalemia (RR=2.89, 95%CI 1.59 to 5.26, P<0.01) adverse reactions were significantly higher than those in non-abiraterone group. The number of drug withdrawals caused by adverse reactions (RR=1.26, 95%CI 0.98 to 1.61, P>0.05), fluid retention or edema (RR=1.23, 95%CI 0.73 to 2.09, P>0.05), liver function damage (RR=1.66, 95%CI 0.93 to 2.97, P>0.05), fatigue and weakness (RR=0.97, 95%CI 0.73 to 1.29, P>0.05), anemia (RR=0.86, 95%CI 0.64 to 1.16, P>0.05) and elevated blood glucose (RR=1.51, 95%CI 0.96 to 2.36, P>0.05), were not significantly different between the two groups. Conclusion Abiraterone acetate can effectively delay the progression of castration-resistant prostate cancer, prolong the survival period, and improve the quality of life. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.