Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospital Trust, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Histopathology. 2024 Nov;85(5):727-742. doi: 10.1111/his.15292. Epub 2024 Aug 7.
Extraprostatic extension (EPE) of prostate cancer is usually reported as either focal (F-EPE) or established (E-EPE), but data on the implication for outcomes of this subdivision are conflicting and no systematic review (SR) evaluating this exists. This SR aims to address this gap in the literature, focusing on the impact of F-EPE and E-EPE on outcome in radical prostatectomy (RP) patients. Searches on Embase, Medline(R), and Pubmed databases were conducted. Studies were included if they investigated the extent of EPE in RP patients and correlated this with defined outcomes (biochemical recurrence [BCR], death, metastasis). Quality was assessed using the Newcastle-Ottawa Scale. A random effects model was used for studies reporting hazard ratios (EPE extent and biochemical recurrence). 24 studies, including 49,187 men, were included. Six studies were of high quality. 20 studies reported how they measured EPE. 13 studies reported that the extent of EPE was associated significantly with BCR. Meta-analysis showed there was a significant correlation between BCR and both F-EPE and E-EPE when compared to organ-confined disease; no significant difference was found between F-EPE and E-EPE. This is the only SR to investigate the extent of EPE on outcomes after RP. EPE alone predicts outcome, but the value of subdivision by extent could not be demonstrated. Comparisons are limited due to variability in EPE assessment and in the methods used to report outcomes in the literature. Further work to standardize EPE reporting methods, in larger cohorts, may be helpful to resolve remaining questions.
前列腺癌的前列腺外延伸（EPE）通常报告为局灶性（F-EPE）或已建立的（E-EPE），但关于这种细分对结局影响的数据存在冲突，并且没有系统评价（SR）对此进行评估。本 SR 旨在解决文献中的这一空白，重点关注 F-EPE 和 E-EPE 对根治性前列腺切除术（RP）患者结局的影响。在 Embase、Medline（R）和 Pubmed 数据库上进行了检索。如果研究调查了 RP 患者的 EPE 程度，并将其与定义的结局（生化复发[BCR]、死亡、转移）相关联，则纳入研究。使用纽卡斯尔-渥太华量表评估质量。对于报告危险比（EPE 程度和生化复发）的研究，使用随机效应模型。共纳入 24 项研究，包括 49187 名男性。其中 6 项研究质量较高。20 项研究报告了他们如何测量 EPE。13 项研究报告称，EPE 程度与 BCR 显著相关。荟萃分析显示，与器官局限性疾病相比，F-EPE 和 E-EPE 与 BCR 之间存在显著相关性；F-EPE 和 E-EPE 之间无显著差异。这是唯一一项调查 RP 后 EPE 程度对结局影响的 SR。EPE 本身可预测结局，但 EPE 程度细分的价值尚无法证明。由于文献中 EPE 评估和报告结局的方法存在差异，因此比较受到限制。进一步的工作可能有助于解决剩余的问题，例如在更大的队列中标准化 EPE 报告方法。
