The effect of additional chemotherapy on high-risk prostate cancer: a systematic review and meta-analysis

Junru Chen,* Xingming Zhang,* Guangxi Sun, Jinge Zhao, Jiandong Liu, Peng Zhao, Jindong Dai, Pengfei Shen, Hao Zeng Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China *These authors contributed equally to this work Objective: The role of additional chemotherapy in the treatment of high-risk prostate cancer (PCa) remains a controversy. This meta-analysis aimed to investigate the effect of additional chemotherapy on high-risk PCa. Methods: Randomized controlled trials (RCTs) about additional chemotherapy for high-risk PCa were searched in PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. We extracted HRs of overall survival (OS) and progression-free survival (PFS) for each trial and performed the meta-analysis using Review Manager 5.3. Results: Eight RCTs involving 4,007 patients were included. Data from four trials, which could collect OS, showed that additional chemotherapy could not significantly improve the OS in patients with high-risk PCa (HR: 0.93; 95% CI: 0.79–1.09; P=0.37). However, the pooled analysis suggested significantly longer PFS in high-risk PCa patients treated with additional chemotherapy (HR: 0.81; 95% CI: 0.74–0.90; P