内脏转移（VM）和更多的骨转移通常定义了转移性去势敏感型前列腺癌（mCSPC）患者的高体积/高风险。关键试验的亚组分析未显示第二代非类固醇抗雄激素（NSAA）对VM患者有明显益处。然而，评估环孢17抑制剂乙酰氨基酮和泼尼松（AAP）的试验的亚组分析显示，在VM患者中，mCSPC患者的总体生存率（OS）有所提高。我们在MEDLINE、Web of Science和国际会议摘要中搜寻了第三期随机对照试验中针对mCSPC患者的第二代NSAA和AAP。在这个汇总分析中，我们纳入了来自6个第三期试验的6485名患者。VM患者的比例为15.2％。有趣的是，与NSAA相比，AAP似乎在VM患者中有效地改善了OS（风险比（HR）：0.89，95％ CI，0.72-1.11，P = .30对于第二代NSAA；HR：0.58，95％ CI，0.40-0.84，P = .004对于AAP）。相反，在没有VM的患者中，第二代NSAA（HR：0.63，95％ CI，0.57-0.70，P < .001）和AAP（HR：0.68，95％ CI，0.57-0.81，P < .001）都改善了OS。在这个汇总分析中，我们证明了AAP对VM患者提供了OS改善，而第二代NSAA在这个人群中没有展现出类似的OS益处。©作者（们）2023。牛津大学出版社出版。

Visceral metastasis (VM) and a higher number of bone metastasis generally define high volume/risk in patients with metastatic castration-sensitive prostate cancer (mCSPC). Subgroup analysis of pivotal trials did not show a clear benefit of second-generation non-steroidal anti-androgens (NSAAs) in patients with VM. However, subgroup analysis of the trial assessing abiraterone acetate, a CYP 17 inhibitor, plus prednisone (AAP) showed an improved overall survival (OS) in patients with mCSPC with VM. We searched MEDLINE, Web of Science, and congress abstracts for the phase III randomized controlled trials of second-generation NSAAs and AAP in patients with mCSPC. In this pooled analysis, we included 6485 patients from the 6 phase III trials. The rate of patients with VM was 15.2%. Interestingly, in contrast to NSAAs, AAP seems to be effective in improving OS among patients with VM (hazard ratio, HR: 0.89, 95% CI, 0.72-1.11, P = .30 for second-generation NSAAs; HR: 0.58, 95% CI, 0.40-0.84, P = .004 for AAP). In contrast, both second-generation NSAAs (HR: 0.63, 95% CI, 0.57-0.70, P < .001) and AAP (HR: 0.68, 95% CI, 0.57-0.81, P < .001) improved OS in patients without VM. In this pooled analysis, we demonstrate that while AAP provided an OS improvement in patients with VM, second-generation NSAAs did not demonstrate a similar OS benefit in this population.© The Author(s) 2023. Published by Oxford University Press.