Abstract
Background and ObjectivesPrevious studies have demonstrated that positive surgical margins (PSMs) were independent predictive factors for biochemical and oncologic outcomes in patients with prostate cancer (PCa). This study aimed to conduct a meta-analysis to identify the predictive factors for PSMs after radical prostatectomy (RP).MethodsWe selected eligible studies via the electronic databases, such as PubMed, Web of Science, and EMBASE, from inception to December 2020. The risk factors for PSMs following RP were identified. The pooled estimates of standardized mean differences (SMDs)/odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A fixed effect or random effect was used to pool the estimates. Subgroup analyses were performed to explore the reasons for heterogeneity.ResultsTwenty-seven studies including 50,014 patients with PCa were eligible for further analysis. The results showed that PSMs were significantly associated with preoperative prostate-specific antigen (PSA) (pooled SMD = 0.37; 95% CI: 0.31–0.43; P < 0.001), biopsy Gleason Score (<6/≥7) (pooled OR = 1.53; 95% CI:1.31–1.79; P < 0.001), pathological Gleason Score (<6/≥7) (pooled OR = 2.49; 95% CI: 2.19–2.83; P < 0.001), pathological stage (<T2/≥T3) (pooled OR = 3.90; 95% CI: 3.18–4.79; P < 0.001), positive lymph node (PLN) (pooled OR = 3.12; 95% CI: 2.28–4.27; P < 0.001), extraprostatic extension (EPE) (pooled OR = 4.44; 95% CI: 3.25–6.09; P < 0.001), and seminal vesicle invasion (SVI) (pooled OR = 4.19; 95% CI: 2,87–6.13; P < 0.001). However, we found that age (pooled SMD = 0.01; 95% CI: −0.07–0.10; P = 0.735), body mass index (BMI) (pooled SMD = 0.12; 95% CI: −0.05–0.30; P = 0.162), prostate volume (pooled SMD = −0.28; 95% CI: −0.62–0.05; P = 0.097), and nerve sparing (pooled OR = 0.90; 95% CI: 0.71–1.14; P = 0.388) had no effect on PSMs after RP. Besides, the findings in this study were found to be reliable by our sensitivity and subgroup analyses.ConclusionsPreoperative PSA, biopsy Gleason Score, pathological Gleason Score, pathological stage, positive lymph node, extraprostatic extension, and seminal vesicle invasion are independent predictors of PSMs after RP. These results may helpful for risk stratification and individualized therapy in PCa patients.
Highlights
Prostate cancer (PCa) is the most common type of newly diagnosed malignancy and a leading cause of cancer-related death in males worldwide (1)
The results of meta-analysis of positive surgical margins (PSMs) showed that no significant associations were found between PSMs and age (RE model, pooled standard mean differences (SMD) = 0.01; 95% corresponding confidence intervals (CIs): −0.07–0.10; P = 0.735, Figure 6A), nerve sparing (RE model, pooled odds ratios (ORs) = 0.90; 95% CI: 0.71–1.14; P = 0.388, Figure 6B), body mass index (BMI) (RE model, pooled SMD = 0.12; 95% CI: −0.05–0.30; P = 0.162, Figure 6C), and prostate volume (RE model, pooled SMD = −0.28; 95% CI: −0.62–0.05; P = 0.097, Figure 6D)
The pooled SMD for preoperative PSA (pPSA) ranged from 0.36 to 0.44 (Supplementary Figure S2A), and the pooled SMD for age ranged from −0.01 to 0.03 (Supplementary Figure S2B)
Summary
Prostate cancer (PCa) is the most common type of newly diagnosed malignancy and a leading cause of cancer-related death in males worldwide (1). A number of factors have been found to be associated with BCR after RP, and one adverse risk factor is the presence of positive surgical margins (PSMs). None of the systematic research studies have reported about the factors that may affect the margin status of PCa after RP. No consensus has been reported regarding the above results Based on these considerations, a comprehensive metaanalysis and systematic review was necessary to evaluate the predictive factors for PSMs in PCa patients following RP. Previous studies have demonstrated that positive surgical margins (PSMs) were independent predictive factors for biochemical and oncologic outcomes in patients with prostate cancer (PCa). This study aimed to conduct a metaanalysis to identify the predictive factors for PSMs after radical prostatectomy (RP)
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