SynthesisFrontiers in oncology2025
Prognostic factors for overall survival in patients with metastatic castration-resistant prostate cancer treated with radium-223: a meta-analysis of real-world evidence.
Synthesis in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Metastatic castration-resistant prostate cancer (mCRPC) remains a lethal disease with limited treatment options. Radium-223 (Ra-223) improves survival in bone-predominant mCRPC, but real-world outcomes vary widely. This meta-analysis synthesizes real-world evidence to identify prognostic factors for overall survival (OS) in Ra-223-treated patients. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and Cochrane Library for observational studies reporting OS-associated prognostic factors in mCRPC patients receiving Ra-223. Pooled hazard ratios (HRs) were calculated. Study quality was assessed via Newcastle-Ottawa Scale. Results: Among 25 studies (n=8,795 patients), the pooled Ra-223 completion rate was 52.6% (95% CI: 48.9-56.3%). Each additional Ra-223 injection significantly improved OS (HR = 0.478, 95% CI: 0.362-0.630). Poorer OS correlated with older age (HR = 1.012/year), higher ECOG (HR = 2.078), elevated baseline PSA (HR = 1.922), ALP (HR = 1.981), LDH (HR = 1.702), NLR (HR = 2.255), and visceral metastases (HR = 2.342). Protective factors included hemoglobin levels (HR = 0.756/g/dL) and PSA/ALP declines during therapy (HR = 0.386 and 0.701, respectively). Prior chemotherapy predicted worse outcomes (HR = 1.425), while Gleason score and concurrent bone protectants showed no significant association. Conclusion: Real-world data confirm Ra-223's survival benefit is closely associated with treatment completion and baseline clinical factors. The findings support risk-stratified patient selection and tailored management in mCRPC.
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