Department of Urology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai, China.
Department of Urology, Fuyang Hospital of Anhui Medical University, Fuyang, China.
Urol Int. 2023;107(5):460-479. doi: 10.1159/000528873. Epub 2023 Mar 29.
Previous studies have revealed that Gleason score upgrading (GSU) was closely related to an increased biochemical recurrence rate and adverse oncologic outcomes in patients with prostate cancer (PC). Therefore, we performed a meta-analysis to determine the predictive factors for GSU following radical prostatectomy (RP).
We performed an extensive literature search using PubMed, Embase, and Cochrane in September 2022. In order to calculate the pooled odds ratio (OR), standardized mean difference (SMD), and 95% confidence intervals, a fixed effect or a DerSimonian and Laird random effect was applied.
Twenty-six studies included 18,745 PC patients that were available for further analysis. Our results revealed that GSU was significantly correlated with age (summary SMD = 0.13; p = 0.004), prostate volume (PV) (summary SMD = -0.19;p < 0.001), preoperative PSA (p-PSA) (summary SMD = 0.18; p < 0.001), PSA density (PSAD) (summary SMD = 0.40; p < 0.001), number of positive cores (summary SMD = 0.28; p = 0.001), percentage of positive cores (summary SMD = 0.36; p < 0.001), Prostate Imaging Reporting and Data System (PI-RADS) scores (>3/≤3) (summary OR = 2.27; p = 0.001), clinical T stage (>T2/≤T2) (summary OR = 1.73; p < 0.001), positive surgical margins (PSM) (summary OR = 2.12; p < 0.001), extraprostatic extension (EPE) (summary OR = 2.73; p < 0.001), pathological T stage (>T2/≤T2) (summary OR = 3.45; p < 0.001), perineural invasion (PNI) (summary OR = 2.40; p = 0.008), and neutrophil to lymphocyte ratio (NLR) (summary SMD = 0.50; p < 0.001). However, we found that GSU was not significantly correlated with body mass index (BMI) (summary SMD = -0.02; p = 0.602). Moreover, our sensitivity and subgroup analyses showed that the findings were reliable.
Age, PV, p-PSA, PSAD, number of positive cores, percentage of positive cores, PI-RADS score, clinical T stage, PSM, EPE, pathological T stage, PNI, and NLR are independent factors predicting GSU following RP. The findings may be helpful in risk stratification and personalized treatment in PC patients.
先前的研究表明，前列腺癌（PC）患者的 Gleason 评分升级（GSU）与生化复发率和不良肿瘤学结局密切相关。因此，我们进行了一项荟萃分析，以确定根治性前列腺切除术后（RP）GSU 的预测因素。
我们于 2022 年 9 月使用 PubMed、Embase 和 Cochrane 进行了广泛的文献检索。为了计算汇总优势比（OR）、标准化均数差（SMD）和 95%置信区间，采用固定效应或 DerSimonian 和 Laird 随机效应。
26 项研究共纳入 18745 例 PC 患者，可进一步分析。我们的结果表明，GSU 与年龄（汇总 SMD=0.13；p=0.004）、前列腺体积（PV）（汇总 SMD=-0.19；p<0.001）、术前 PSA（p-PSA）（汇总 SMD=0.18；p<0.001）、PSA 密度（PSAD）（汇总 SMD=0.40；p<0.001）、阳性核心数（汇总 SMD=0.28；p=0.001）、阳性核心百分比（汇总 SMD=0.36；p<0.001）、前列腺影像报告和数据系统（PI-RADS）评分（>3/≤3）（汇总 OR=2.27；p=0.001）、临床 T 分期（>T2/≤T2）（汇总 OR=1.73；p<0.001）、阳性切缘（PSM）（汇总 OR=2.12；p<0.001）、前列腺外延伸（EPE）（汇总 OR=2.73；p<0.001）、病理 T 分期（>T2/≤T2）（汇总 OR=3.45；p<0.001）、神经周围侵犯（PNI）（汇总 OR=2.40；p=0.008）和中性粒细胞与淋巴细胞比值（NLR）（汇总 SMD=0.50；p<0.001）显著相关。然而，我们发现 GSU 与体重指数（BMI）（汇总 SMD=-0.02；p=0.602）无显著相关性。此外，我们的敏感性和亚组分析表明，这些发现是可靠的。
年龄、PV、p-PSA、PSAD、阳性核心数、阳性核心百分比、PI-RADS 评分、临床 T 分期、PSM、EPE、病理 T 分期、PNI 和 NLR 是 RP 后 GSU 的独立预测因素。这些发现可能有助于 PC 患者的风险分层和个体化治疗。
