SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Radiation Oncology
This article is part of the Research TopicReal World-Evidence in Radioligand Therapy: Above and Beyond a Tongue TwisterView all articles
Prognostic Factors for Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Radium-223: A Meta-Analysis of Real-World Evidence
Provisionally accepted
- Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
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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.
Keywords: Prognostic factor, overall survival, radium-223, castration-resistant prostate cancer, Real-world
Received: 24 Jul 2025; Accepted: 29 Oct 2025.
Copyright: © 2025 Song, Shao, He, Zhu and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Baolin Song, baolin_song@126.com
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