Predictive Factors for Positive Surgical Margins in Patients With Prostate Cancer After Radical Prostatectomy: A Systematic Review and Meta-Analysis

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Feb 25

PMID 33628724

Citations 6

Authors

Lijin Zhang

Hu Zhao

Bin Wu

Zhenlei Zha

Jun Yuan

Yejun Feng

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: 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 meta-analysis to identify the predictive factors for PSMs after radical prostatectomy (RP).

Methods: We selected eligible studies 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.

Results: Twenty-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.

Conclusions: Preoperative 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.

Citing Articles

Lesion-based grading system using clinicopathological and MRI features for predicting positive surgical margins in prostate cancer.

Xu H, Chen D, Ma Y, Ning X, Bai X, Liu B Abdom Radiol (NY). 2025; .

PMID: 39870823 DOI: 10.1007/s00261-025-04808-z.

Accuracy of the LaserSAFE technique for detecting positive surgical margins during robot-assisted radical prostatectomy: blind assessment and inter-rater agreement analysis.

Almeida-Magana R, Au M, Al-Hammouri T, Mathew M, Dinneen K, Mendes L Histopathology. 2024; 86(3):433-440.

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Development of preoperative nomograms to predict the risk of overall and multifocal positive surgical margin after radical prostatectomy.

Xu L, Peng Q, Zhang G, Zhang D, Zhang J, Zhang X Cancer Imaging. 2024; 24(1):104.

PMID: 39118144 PMC: 11312749. DOI: 10.1186/s40644-024-00749-w.

The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: A systematic review and meta-analysis.

Guo H, Zhang L, Shao Y, An K, Hu C, Liang X PLoS One. 2024; 19(7):e0301653.

PMID: 38990870 PMC: 11239040. DOI: 10.1371/journal.pone.0301653.

An MRI-based grading system for preoperative risk estimation of positive surgical margin after radical prostatectomy.

Xu L, Zhang G, Zhang D, Zhang J, Zhang X, Bai X Insights Imaging. 2023; 14(1):178.

PMID: 37872408 PMC: 10593712. DOI: 10.1186/s13244-023-01516-4.

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