Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis

Abstract

Background and Objectives: This study aims to elucidate the positive rate and the clinicopathological significance of surgical margin after radical prostatectomy (RP) through a meta-analysis. Materials and Methods: This meta-analysis finally used 59 studies, including the information about the positive surgical margin (PSM) and those clinicopathological significances after RP. The subgroup analysis for the estimated rates of PSM was evaluated based on types of surgery, grade groups, and pathological tumor (pT) stages. We compared the clinicopathological correlations between positive and negative surgical margins (NSM). Results: The estimated PSM rate was 25.3% after RP (95% confidence interval [CI] 21.9–29.0%). The PSM rates were 26.0% (95% CI 21.5–31.1%) 28.0% (95% CI 20.2–37.5%) in robot-assisted RP and nerve-sparing RP, respectively. The PSM rate was significantly higher in high-grade groups than in low-grade groups. In addition, the higher pT stage subgroup had a high PSM rate compared to the lower pT stage subgroups. Patients with PSM showed significantly high PSA levels, frequent lymphovascular invasion, lymph node metastasis, and extraprostatic extension. Biochemical recurrences (BCRs) were 28.5% (95% CI 21.4–36.9%) and 11.8% (95% CI 8.1–16.9%) in PSM and NSM subgroups, respectively. Patients with PSM showed worse BCR-free survival than those with NSM (hazard ratio 2.368, 95% CI 2.043–2.744%). Conclusions: Our results showed that PSM was significantly correlated with worse clinicopathological characteristics and biochemical recurrence-free survival. Among the results in preoperative evaluations, grade group and tumor stage are useful for the prediction of PSM.

Initial experience and short-term outcomes of single-port extraperitoneal transvesical robot-assisted radical prostatectomy: a two-center study

“…Furthermore, an additional limitation of this study is the absence of comparative analysis with other established techniques of RARP Finally, due to the concerns of surgical margins and urinary leakage, we only restricted our inclusion criteria to low-median risk PCa patients with comparatively small prostate volumes. It had been reported that the positive surgical margin rates after radical prostatectomy ranged from 6.2% to 71.5%, and patients with positive surgical margins had worse BCR-free survivals than those without positive surgical margins ( 19 ). Kim et al found that tumor location was not a risk factor of postoperative biochemical recurrence ( 19 ).…”

“…It had been reported that the positive surgical margin rates after radical prostatectomy ranged from 6.2% to 71.5%, and patients with positive surgical margins had worse BCR-free survivals than those without positive surgical margins ( 19 ). Kim et al found that tumor location was not a risk factor of postoperative biochemical recurrence ( 19 ). However, it was notable that there was no significant correlation between positive surgical margin and cancer-specific survivals according to the long-term follow-up data ( 19 ).…”

“…Kim et al found that tumor location was not a risk factor of postoperative biochemical recurrence ( 19 ). However, it was notable that there was no significant correlation between positive surgical margin and cancer-specific survivals according to the long-term follow-up data ( 19 ). As such, further investigations are needed in the future to validate the feasibility of the technique in patients with either enlarged prostates or high-risk disease.…”

Value of three-dimensional visualization of preoperative prostatic magnetic resonance imaging based on measurements of anatomical structures in predicting positive surgical margin after radical prostatectomy

“…PSM is a complex issue for urologists since it is strongly associated with worse clinical outcomes ( 6 , 39 ). The cutoff PSM rate in our study was 27.5%, which is high in view of the global PSM rate of 6.5-32% ( 6 ), but in the Asian region, the cutoff rate has been approximately 21.9%-38.3%, making our rate low to moderate there ( 19 , 40 – 43 ).…”

Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Parameters Could Predict International Society of Urological Pathology Risk Groups of Prostate Cancers on Radical Prostatectomy

“…Radical prostatectomy (RP) is a therapeutic procedure for clinically localized and locally advanced PCa that aims to surgically eradicate malignant tumors and ensure complete removal of the entire prostate gland and surrounding structures for optimal oncological control. However, positive surgical margins (PSMs) still occur after RP and may increase the risk of postoperative biochemical recurrence [ 15 , 16 , 17 ]. Since PSMs may suggest an adverse prognosis for PCa treatment, there is a need to identify risk factors for PSMs.…”