Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China.
PLoS One. 2024 Jul 11;19(7):e0301653. doi: 10.1371/journal.pone.0301653. eCollection 2024.
To systematically review and perform a meta-analysis on the predictive value of the primary Gleason grade (PGG) at the positive surgical margin (PSM), length of PSM, number of PSMs, and pathological stage of the primary tumor on biochemical recurrence (BCR) in patients with prostate cancer (PCa) after radical prostatectomy (RP).
A systematic literature search was performed using electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, from January 1, 2005, to October 1, 2023. The protocol was pre-registered in PROSPERO. Subgroup analyses were performed according to the different treatments and study outcomes. Pooled hazard ratios with 95% confidence intervals were extracted from multivariate analyses, and a fixed or random effect model was used to pool the estimates. Subgroup analyses were performed to explore the reasons for the heterogeneity.
Thirty-one studies that included 50,028 patients with PCa were eligible for this meta-analysis. The results showed that, compared to PGG3, PGG4/5 was associated with a significantly increased risk of BCR. Compared with PSM ≤3 mm, PSM ≥3 mm was associated with a significantly increased risk of BCR. Compared with unifocal PSM, multifocal PSM (mF-PSM) was associated with a significantly increased risk of BCR. In addition, pT >2 was associated with a significantly increased risk of BCR compared to pT2. Notably, the findings were found to be reliable based on the sensitivity and subgroup analyses.
PGG at the PSM, length of PSM, number of PSMs, and pathological stage of the primary tumor in patients with PCa were found to be associated with a significantly increased risk of BCR. Thus, patients with these factors should be treated differently in terms of receiving adjunct treatment and more frequent monitoring. Large-scale, well-designed prospective studies with longer follow-up periods are needed to validate the efficacy of these risk factors and their effects on patient responses to adjuvant and salvage therapies and other oncological outcomes.
系统回顾并进行荟萃分析，评估前列腺癌（PCa）患者根治性前列腺切除术后（RP）在阳性切缘（PSM）、PSM 长度、PSM 数量和原发肿瘤病理分期的主要 Gleason 分级（PGG）对生化复发（BCR）的预测价值。
使用电子数据库（包括 PubMed、EMBASE、Cochrane 图书馆和 Web of Science）从 2005 年 1 月 1 日至 2023 年 10 月 1 日进行系统文献检索。方案在 PROSPERO 中预先注册。根据不同的治疗方法和研究结果进行亚组分析。从多变量分析中提取具有 95%置信区间的合并风险比，并使用固定或随机效应模型合并估计值。进行亚组分析以探讨异质性的原因。
共有 31 项研究纳入了 50028 例 PCa 患者，符合本荟萃分析的纳入标准。结果表明，与 PGG3 相比，PGG4/5 与 BCR 的风险显著增加相关。与 PSM≤3mm 相比，PSM≥3mm 与 BCR 的风险显著增加相关。与单灶 PSM 相比，多灶 PSM（mF-PSM）与 BCR 的风险显著增加相关。此外，与 pT2 相比，pT>2 与 BCR 的风险显著增加相关。值得注意的是，敏感性分析和亚组分析结果表明这些发现是可靠的。
在 PCa 患者中，PSM 处的 PGG、PSM 长度、PSM 数量和原发肿瘤病理分期与 BCR 的风险显著增加相关。因此，对于具有这些因素的患者，在接受辅助治疗和更频繁的监测方面应采取不同的治疗方法。需要进行大规模、精心设计的前瞻性研究，以验证这些风险因素的疗效及其对辅助和挽救治疗及其他肿瘤学结局的影响。
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