Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies

Abstract

Background and purposeAlthough numerous studies have shown that positive surgical margin (PSM) is linked to biochemical recurrence (BCR) in prostate cancer (PCa), the research results have been inconsistent. This study aimed to explore the association between PSM and BCR in patients with PCa following radical prostatectomy (RP).Materials and methodsIn accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, EMBASE and Wan Fang databases were searched for eligible studies from inception to November 2017. The Newcastle–Ottawa Scale was used to assess the risk of bias of the included studies. Meta-analysis was performed by using Stata 12.0. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models.ResultsUltimately, 41 retrospective cohort studies of high quality that met the eligibility criteria, comprising 37,928 patients (94–3294 per study), were included in this meta-analysis. The results showed that PSM was associated with higher BCR risk in both univariate analysis (pooled HR = 1.56; 95% CI 1.46, 1.66; p < 0.001) and multivariate analysis (pooled HR = 1.35; 95% CI 1.27, 1.43; p < 0.001). Moreover, no potential publication bias was observed among the included studies in univariate analysis (p-Begg = 0.971) and multivariate analysis (p-Begg = 0.401).ConclusionsOur meta-analysis demonstrated that PSM is associated with a higher risk of BCR in PCa following RP and could serve as an independent prognostic factor in patients with PCa.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1433-3) contains supplementary material, which is available to authorized users.

The predictor factors for positive surgical margins in patients of prostate cancer after radical prostatectomy: a systematic review and meta-analysis

“…Consistent with these findings, our recent studies [6,7] demonstrated the adverse effect of PSMs on both BCR and cancer-specific survival through systematic review and meta-analysis. However, not all patients with PSMs have poor tumor outcomes, some patients with localized PCa will occur tumor progression even in the NSMs.…”

“…Our previous findings have indicate that PSMs are significantly associated with BCR and poor survival outcome after RC [6,7]. However, no systematic research studies have shown which factors that may affecting the margin of PCa after RC.…”

Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

“…FS. As a PSM is an adverse outcome of RP that is associated with worse oncological endpoints , knowledge of the SM status during surgery helps in tailoring the next steps of RP based on the individual aggressiveness and extension of the prostate cancer.…”

Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH

“…Although the impact of PSMs on long‐term cancer outcomes is controversial, it does predict recurrence 11–13 and secondary radiation therapy, 14 which can negatively impact quality of life 15 . Since the Food and Drug Administration approved robotic surgery in 2000, RALP has become a widely adapted surgical technique in the USA, and is increasing in Europe.…”