John Athul, John Hritik, Catterwell Rick, Selth Luke A, Callaghan Michael O
Adelaide Medical School, University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia.
Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
BJU Int. 2021 May;127 Suppl 1:13-22. doi: 10.1111/bju.15316.
To systematically review and perform a meta-analysis of studies investigating the role of primary Gleason grade (PGG), Gleason score (GS) or Gleason grade group (GGG) at positive surgical margins (PSMs) after radical prostatectomy (RP) in predicting biochemical recurrence (BCR) and oncological outcomes.
A systematic search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies published between 2005 and 2019 were included. The quality of the studies selected was assessed, and a protocol was registered and published in advance (PROSPERO: CRD42019131800). The primary outcome measure was BCR. Secondary outcome measures included cancer-specific survival, metastasis-free survival and overall mortality during the follow-up period.
Our systematic search yielded 3116 unique results. Ten studies were selected for meta-analysis. The sample sizes of PSM cohorts varied from 200 to 956, while the median follow-up ranged from 1.5 to 13 years. Most studies used BCR as a surrogate marker for disease progression; only two studies reported other oncological outcomes. Meta-analysis was performed in selected groups (PGG, GS and GGG). PGG 4 or 5 at the PSM was found to be predictive of BCR (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.37-2.02; P < 0.01). GGG > 1 at margin was also predictive of BCR compared to GGG 1 (GGG 1 vs 2: HR 2.35, 95% CI 1.6 -3.46; P < 0.001; GGG 1 vs 3: HR 3.95, 95% CI 1.82-8.57; P = 0.005; GGG 1 vs 4: HR 7.17, 95% CI 1.76-29.17; P = 0.006; and GGG 1 vs 5: HR 12.37, 95% CI 1.80-84.82; P = 0.01).
Gleason score, PGG and GGG at the PSM are associated with a significantly increased risk of BCR. Longer-term studies are needed to investigate the utility of PGG, GS or GGG at the PSM in their ability to predict not only BCR but other outcomes such as cancer-specific survival, metastasis-free survival and overall survival.
系统评价并进行荟萃分析，以研究在根治性前列腺切除术（RP）后，手术切缘阳性（PSM）时原发性Gleason分级（PGG）、Gleason评分（GS）或Gleason分级组（GGG）在预测生化复发（BCR）及肿瘤学结局中的作用。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用MEDLINE、Scopus、Embase和Cochrane数据库进行系统检索。纳入2005年至2019年发表的研究。对所选研究的质量进行评估，并预先注册和发表了一项方案（PROSPERO：CRD42019131800）。主要结局指标为BCR。次要结局指标包括随访期间的癌症特异性生存、无转移生存和总死亡率。
我们的系统检索产生了3116个独特结果。选择了10项研究进行荟萃分析。PSM队列的样本量从200到956不等，而中位随访时间为1.5至13年。大多数研究使用BCR作为疾病进展的替代标志物；只有两项研究报告了其他肿瘤学结局。在选定的组（PGG、GS和GGG）中进行了荟萃分析。发现PSM处的PGG 4或5可预测BCR（风险比[HR] 1.66，95%置信区间[CI] 1.37 - 2.02；P < 0.01）。与GGG 1相比，切缘处的GGG > 1也可预测BCR（GGG 1对比2：HR 2.35，95% CI 1.6 - 3.46；P < 0.001；GGG 1对比3：HR 3.95，95% CI 1.82 - 8.57；P = 0.005；GGG 1对比4：HR 7.17，95% CI 1.76 - 29.17；P = 0.006；GGG 1对比5：HR 12.37，95% CI 1.80 - 84.82；P = 0.01）。
PSM处的Gleason评分、PGG和GGG与BCR风险显著增加相关。需要进行长期研究，以探讨PSM处的PGG、GS或GGG在预测BCR以及其他结局（如癌症特异性生存、无转移生存和总生存）方面的效用。
Zotero 插件