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

Abstract

Background and objectives The previous studies had demonstrate that positive surgical margins (PSMs) was independent predictive factor for biochemical and oncologic outcome in patients with prostate cancer (PCa). This study aimed to conduct a meta-analysis to identify predictive factors for PSMs after radical prostatectomy (RP). Methods We selected eligible studies via electronic database of PubMed, Web of Science and EMBASE from inception to February 2019. The risk factors for PSMs following RP were identificated. 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 two studies including 44,144 patients with PCa were eligible for further analysis. The results showed that PSMs were significantly associated with preoperative PSA(pooled SMD=0.44; 95% CI:0.35–0.54; P<0.001), biopsy Gleason Score (< 6/ ≥7) (pooled OR=1.51; 95% CI:1.26–1.81; P<0.001), pathological Gleason Score (< 6/ ≥7) (pooled OR= 2.34; 95% CI:2.02–2.71; P<0.001), pathological stage (<0.001), positive lymph node (pooled OR=3.08; 95% CI:1.94–5.01; P<0.001), extraprostatic extension (pooled OR=4.86; 95% CI:3.11–7.57; P<0.001) and seminal vesicle invasion (pooled OR=3.56; 95% CI:2,26–5.62; P<0.001). However, we found that age (pooled SMD=-0.01; 95% CI: -0.07–0.04; P=0.656), body mass index (pooled SMD=0.06; 95% CI: -0.03–0.15; P=0.173), prostate volume (pooled SMD=-0.28; 95% CI: -0.62–0.05; P=0.097) and nerve sparing (pooled OR=0.94; 95% CI: 0.68–1.29; P=0.705) had no effect on PSMs after RC. Besides, the findings in this study were demonstrated to be reliable by our sensitivity and subgroup analysis. 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 RC. These results may useful to risk stratification and individualized therapy in PCa patients.