根治性前列腺切除术后手术切缘阳性部位的影响：一项网状Meta分析

Impact of positive surgical margin location after radical prostatectomy: a network meta-analysis.

作者信息

John Athul, Milton Thomas, Gupta Aashray, Nguyen Mau T, Stretton Brandon, Hewitt Joseph, Virgin James, Kovoor Joshua, Catterwell Rick, Selth Luke, Callaghan Michael O

机构信息

Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia.

Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.

出版信息

World J Urol. 2025 Feb 22;43(1):134. doi: 10.1007/s00345-025-05479-7.

DOI:10.1007/s00345-025-05479-7

PMID:39985570

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11846713/

Abstract

OBJECTIVE

To perform a network meta-analysis comparing the impact of different positive surgical margin locations (Comparisons and intervention) on biochemical recurrence (Outcome) in patients undergoing radical prostatectomy (Population).

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a protocol was registered (PROSPERO: CRD42022119025) and a search across four databases was conducted (the MEDLINE, Scopus, Embase and Cochrane). The primary outcome was biochemical recurrence (BCR). A network meta-analysis was conducted. Further subgroup analysis was performed to evaluate studies exploring robot-assisted radical prostatectomy (RALP).

RESULTS

Our search yielded 1249 unique results; 22 studies were analysed. Anterior margins had the highest risk of BCR (HR 2.46, 95%CI 1.67-3.61, I = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I = 60%). Given significant heterogeneity, subgroup analysis was performed. In the RALP subgroup, anterior margins also demonstrated the highest recurrence risk (HR 3.74, 95%CI 2.47-5.66, I = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).

CONCLUSIONS

The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.

摘要

目的

进行一项网状荟萃分析，比较不同阳性手术切缘位置（比较和干预措施）对接受根治性前列腺切除术患者（总体人群）生化复发（结局）的影响。

方法

根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，登记了一项方案（PROSPERO：CRD42022119025），并在四个数据库（MEDLINE、Scopus、Embase和Cochrane）中进行了检索。主要结局为生化复发（BCR）。进行了网状荟萃分析。还进行了进一步的亚组分析，以评估探索机器人辅助根治性前列腺切除术（RALP）的研究。

结果

我们的检索产生了1249个独特结果；分析了22项研究。前切缘的BCR风险最高（HR 2.46，95%CI 1.67-3.61，I² = 76%），其次是后切缘（HR 2.29，95%CI 1.43-3.66，I² = 0%）、膀胱基部切缘（HR 2.06，95%CI 1.61-2.64，I² = 69%）、尖部切缘（HR 1.88，95%CI 1.51-2.35，I² = 59%）和后外侧切缘（HR 1.70，95%CI 1.14-2.25，I² = 60%）。鉴于存在显著异质性，进行了亚组分析。在RALP亚组中，前切缘的复发风险也最高（HR 3.74，95%CI 2.47-5.66，I² = 0%），其次是尖部切缘（HR 2.43，95%CI 1.97-8.00，I² = 0%）、后切缘（HR 2.23，95%CI 1.47-3.38）、基部切缘（HR 1.65，95%CI 1.29-2.11，I² = 0%）和后外侧切缘（HR 1.54，95%CI 1.07-2.22）。