Comparative efficacy and safety of treatments for localised prostate cancer an application of network meta-analysis

Tengbin Xiong; Rebecca M Turner; Yinghui Wei; David E Neal; Georgios Lyratzopoulos; Julian P T Higgins

doi:10.1136/bmjopen-2013-004285

Comparative efficacy and safety of treatments for localised prostate cancer an application of network meta-analysis

Tengbin Xiong, Rebecca M Turner, Yinghui Wei, David E Neal, Georgios Lyratzopoulos, Julian P T Higgins

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

34 Citations (Scopus)

Abstract

CONTEXT: There is ongoing uncertainty about the optimal management of patients with localised prostate cancer.

OBJECTIVE: To evaluate the comparative efficacy and safety of different treatments for patients with localised prostate cancer.

DESIGN: Systematic review with Bayesian network meta-analysis to estimate comparative ORs, and a score (0-100%) that, for a given outcome, reflects average rank order of superiority of each treatment compared against all others, using the Surface Under the Cumulative RAnking curve (SUCRA) statistic.

DATA SOURCES: Electronic searches of MEDLINE without language restriction.

STUDY SELECTION: Randomised trials comparing the efficacy and safety of different primary treatments (48 papers from 21 randomised trials included 7350 men).

DATA EXTRACTION: 2 reviewers independently extracted data and assessed risk of bias.

RESULTS: Comparative efficacy and safety evidence was available for prostatectomy, external beam radiotherapy (different types and regimens), observational management and cryotherapy, but not high-intensity focused ultrasound. There was no evidence of superiority for any of the compared treatments in respect of all-cause mortality after 5 years. Cryotherapy was associated with less gastrointestinal and genitourinary toxicity than radiotherapy (SUCRA: 99% and 77% for gastrointestinal and genitourinary toxicity, respectively).

CONCLUSIONS: The limited available evidence suggests that different treatments may be optimal for different efficacy and safety outcomes. These findings highlight the importance of informed patient choice and shared decision-making about treatment modality and acceptable trade-offs between different outcomes. More trial evidence is required to reduce uncertainty. Network meta-analysis may be useful to optimise the power of evidence synthesis studies once data from new randomised controlled studies in this field are published in the future.

Original language	English
Pages (from-to)	e004285
Journal	BMJ Open
Volume	4
Issue number	5
DOIs	https://doi.org/10.1136/bmjopen-2013-004285
Publication status	Published - 15 May 2014

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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title = "Comparative efficacy and safety of treatments for localised prostate cancer an application of network meta-analysis",

abstract = "CONTEXT: There is ongoing uncertainty about the optimal management of patients with localised prostate cancer.OBJECTIVE: To evaluate the comparative efficacy and safety of different treatments for patients with localised prostate cancer.DESIGN: Systematic review with Bayesian network meta-analysis to estimate comparative ORs, and a score (0-100\%) that, for a given outcome, reflects average rank order of superiority of each treatment compared against all others, using the Surface Under the Cumulative RAnking curve (SUCRA) statistic.DATA SOURCES: Electronic searches of MEDLINE without language restriction.STUDY SELECTION: Randomised trials comparing the efficacy and safety of different primary treatments (48 papers from 21 randomised trials included 7350 men).DATA EXTRACTION: 2 reviewers independently extracted data and assessed risk of bias.RESULTS: Comparative efficacy and safety evidence was available for prostatectomy, external beam radiotherapy (different types and regimens), observational management and cryotherapy, but not high-intensity focused ultrasound. There was no evidence of superiority for any of the compared treatments in respect of all-cause mortality after 5 years. Cryotherapy was associated with less gastrointestinal and genitourinary toxicity than radiotherapy (SUCRA: 99\% and 77\% for gastrointestinal and genitourinary toxicity, respectively).CONCLUSIONS: The limited available evidence suggests that different treatments may be optimal for different efficacy and safety outcomes. These findings highlight the importance of informed patient choice and shared decision-making about treatment modality and acceptable trade-offs between different outcomes. More trial evidence is required to reduce uncertainty. Network meta-analysis may be useful to optimise the power of evidence synthesis studies once data from new randomised controlled studies in this field are published in the future.",

author = "Tengbin Xiong and Turner, \{Rebecca M\} and Yinghui Wei and Neal, \{David E\} and Georgios Lyratzopoulos and Higgins, \{Julian P T\}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2014",

month = may,

day = "15",

doi = "10.1136/bmjopen-2013-004285",

language = "English",

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T1 - Comparative efficacy and safety of treatments for localised prostate cancer an application of network meta-analysis

AU - Xiong, Tengbin

AU - Turner, Rebecca M

AU - Wei, Yinghui

AU - Neal, David E

AU - Lyratzopoulos, Georgios

AU - Higgins, Julian P T

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2014/5/15

Y1 - 2014/5/15

N2 - CONTEXT: There is ongoing uncertainty about the optimal management of patients with localised prostate cancer.OBJECTIVE: To evaluate the comparative efficacy and safety of different treatments for patients with localised prostate cancer.DESIGN: Systematic review with Bayesian network meta-analysis to estimate comparative ORs, and a score (0-100%) that, for a given outcome, reflects average rank order of superiority of each treatment compared against all others, using the Surface Under the Cumulative RAnking curve (SUCRA) statistic.DATA SOURCES: Electronic searches of MEDLINE without language restriction.STUDY SELECTION: Randomised trials comparing the efficacy and safety of different primary treatments (48 papers from 21 randomised trials included 7350 men).DATA EXTRACTION: 2 reviewers independently extracted data and assessed risk of bias.RESULTS: Comparative efficacy and safety evidence was available for prostatectomy, external beam radiotherapy (different types and regimens), observational management and cryotherapy, but not high-intensity focused ultrasound. There was no evidence of superiority for any of the compared treatments in respect of all-cause mortality after 5 years. Cryotherapy was associated with less gastrointestinal and genitourinary toxicity than radiotherapy (SUCRA: 99% and 77% for gastrointestinal and genitourinary toxicity, respectively).CONCLUSIONS: The limited available evidence suggests that different treatments may be optimal for different efficacy and safety outcomes. These findings highlight the importance of informed patient choice and shared decision-making about treatment modality and acceptable trade-offs between different outcomes. More trial evidence is required to reduce uncertainty. Network meta-analysis may be useful to optimise the power of evidence synthesis studies once data from new randomised controlled studies in this field are published in the future.

AB - CONTEXT: There is ongoing uncertainty about the optimal management of patients with localised prostate cancer.OBJECTIVE: To evaluate the comparative efficacy and safety of different treatments for patients with localised prostate cancer.DESIGN: Systematic review with Bayesian network meta-analysis to estimate comparative ORs, and a score (0-100%) that, for a given outcome, reflects average rank order of superiority of each treatment compared against all others, using the Surface Under the Cumulative RAnking curve (SUCRA) statistic.DATA SOURCES: Electronic searches of MEDLINE without language restriction.STUDY SELECTION: Randomised trials comparing the efficacy and safety of different primary treatments (48 papers from 21 randomised trials included 7350 men).DATA EXTRACTION: 2 reviewers independently extracted data and assessed risk of bias.RESULTS: Comparative efficacy and safety evidence was available for prostatectomy, external beam radiotherapy (different types and regimens), observational management and cryotherapy, but not high-intensity focused ultrasound. There was no evidence of superiority for any of the compared treatments in respect of all-cause mortality after 5 years. Cryotherapy was associated with less gastrointestinal and genitourinary toxicity than radiotherapy (SUCRA: 99% and 77% for gastrointestinal and genitourinary toxicity, respectively).CONCLUSIONS: The limited available evidence suggests that different treatments may be optimal for different efficacy and safety outcomes. These findings highlight the importance of informed patient choice and shared decision-making about treatment modality and acceptable trade-offs between different outcomes. More trial evidence is required to reduce uncertainty. Network meta-analysis may be useful to optimise the power of evidence synthesis studies once data from new randomised controlled studies in this field are published in the future.

U2 - 10.1136/bmjopen-2013-004285

DO - 10.1136/bmjopen-2013-004285

M3 - Article (Academic Journal)

C2 - 24833678

SN - 2044-6055

VL - 4

SP - e004285

JO - BMJ Open

JF - BMJ Open

IS - 5

ER -

Comparative efficacy and safety of treatments for localised prostate cancer an application of network meta-analysis

Abstract

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