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Background:
Systematic Review

Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis

by
Minseok Kim
1,†,
Daeseon Yoo
2,†,
Jungsoo Pyo
3 and
Wonjin Cho
1,*
1
Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Korea
2
Department of Urology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea
3
Department of Pathology, Uijeongbu Eulji University Hospital, Eulji University School of Medicine, Uijeongbu 11759, Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2022, 58(9), 1251; https://doi.org/10.3390/medicina58091251
Submission received: 7 July 2022 / Revised: 12 August 2022 / Accepted: 26 August 2022 / Published: 9 September 2022
(This article belongs to the Special Issue Research Progress of Surgical Oncology)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background and Objectives: This study aims to elucidate the positive rate and the clinicopathological significance of surgical margin after radical prostatectomy (RP) through a meta-analysis. Materials and Methods: This meta-analysis finally used 59 studies, including the information about the positive surgical margin (PSM) and those clinicopathological significances after RP. The subgroup analysis for the estimated rates of PSM was evaluated based on types of surgery, grade groups, and pathological tumor (pT) stages. We compared the clinicopathological correlations between positive and negative surgical margins (NSM). Results: The estimated PSM rate was 25.3% after RP (95% confidence interval [CI] 21.9–29.0%). The PSM rates were 26.0% (95% CI 21.5–31.1%) 28.0% (95% CI 20.2–37.5%) in robot-assisted RP and nerve-sparing RP, respectively. The PSM rate was significantly higher in high-grade groups than in low-grade groups. In addition, the higher pT stage subgroup had a high PSM rate compared to the lower pT stage subgroups. Patients with PSM showed significantly high PSA levels, frequent lymphovascular invasion, lymph node metastasis, and extraprostatic extension. Biochemical recurrences (BCRs) were 28.5% (95% CI 21.4–36.9%) and 11.8% (95% CI 8.1–16.9%) in PSM and NSM subgroups, respectively. Patients with PSM showed worse BCR-free survival than those with NSM (hazard ratio 2.368, 95% CI 2.043–2.744%). Conclusions: Our results showed that PSM was significantly correlated with worse clinicopathological characteristics and biochemical recurrence-free survival. Among the results in preoperative evaluations, grade group and tumor stage are useful for the prediction of PSM.

1. Introduction

Prostate cancer was the most diagnosed cancer in men, and it was reported as the fourth most diagnosed cancer in the entire population [1]. Radical prostatectomy (RP) is one of the most effective and most used treatment methods for patients with localized prostate cancer. The surgical techniques have been developed from open RP in the 20th century to laparoscopic surgery and robotic surgery in recent decades [2,3]. There was no statistically significant difference in surgical, oncological, and functional results between these surgical techniques [4]. Despite advances in surgical procedures, 30% of patients undergoing RP still experience biochemical recurrence (BCR) [5]. In addition, in some cases in 20–30% of prostatic cancers progress to metastatic cancer and die [6]. A positive surgical margin (PSM) means that cancer cells are found at the surgical margin in the pathologic specimen after RP. The neurovascular bundle, bladder neck, and distal urethral sphincter are preserved to maintain urinary continence and erectile function, increasing the risk of PSM [7]. It has been reported that the operator’s surgical skills affect PSM or BCR in open or laparoscopic RP, but a recent large scale retrospective study showed that the surgical learning curve had no effect in robot-assisted radical prostatectomy [8,9]. The rate of PSM after RP was reported to occur at about 11 to 38% [10]. Previous studies have reported on the impacting factors causing BCR after RP, and among them, several studies have been published on the relevance of PSM. Although several studies have shown that patients with PSM after RP have a worse prognosis than those without PSM [11], some discrepancies in the clinicopathological significance of PSM are present. PSM is associated with BCR, prostate cancer survival rate, and distant metastasis [12,13]. However, some studies have reported that PSM is not significantly related to the patient’s oncological prognosis [14] and Dev, Harveer S., et al. reported that the length of PSM and apical PSM were related to BCR [15].
We performed this study to elucidate the positive rate and the clinicopathological significance of surgical margin after RP through a meta-analysis. In addition, a subgroup analysis, based on types of surgery, grade groups, and pathological tumor (pT) stages, was conducted in the present study.

2. Materials and Methods

2.1. Published Study Search and Selection Criteria

The literature search was performed using the PubMed and MEDLINE databases through 30 June 2020. The search was performed using the following keywords: “(prostate or prostatic) and (cancer or adenocarcinoma)” and “(radical prostatectomy)” and “(positive surgical margin).” The titles and abstracts of searched articles were primarily screened for exclusion. PICO (population, intervention, comparator, outcomes) was defined as, (1) population: patients with prostatic cancer; (2) intervention: RP; (3) comparator: the presence of PSM; and (4) outcomes: the rate of PSM and BCR-free survival. Literature or systematic review articles were also screened to find additional eligible studies. The inclusion and exclusion criteria were as follows: (1) studies for PSM after RP were included, and (2) non-original articles, such as case reports or review articles were excluded.

2.2. Data Extraction

For the meta-analysis, data were extracted in the eligible studies as follows [7,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73]: the first author’s name, study location, study year, type of surgery, number of patients analyzed, patients’ age, prostate-specific antigen (PSA), and rates of lymphovascular invasion, perineural invasion, lymph node metastasis, and extraprostatic extension. In addition, biochemical-free recurrence and survival rate by the positivity of surgical margins were extracted from eligible studies. For the quantitative aggregation of survival results, the correlation between PSM and survival rate was analyzed according to the hazard ratio (HR), using one of three methods. In studies not reporting the HR or its confidence interval (CI), these variables were calculated from the presented data using the HR point estimate, log-rank statistic or its p-value, and the O-E statistic (the difference between the number of observed and expected events) or its variance. If those data were unavailable, the HR was estimated using the total number of events, the number of patients at risk in each group, and the log-rank statistic or its p-value. Finally, if the only useful data were in the form of graphical representations of survival distributions, survival rates were extracted at specified times to reconstruct the HR estimate and its variance under the assumption that patients were censored at a constant rate during the time intervals. The published survival curves were evaluated independently by two authors to reduce variability. The HRs were then combined into an overall HR using Peto’s method [74].

2.3. Statistical Analyses

To perform a meta-analysis, the Comprehensive Meta-Analysis software package was used (Biostat, Englewood, NJ, USA). The PSM rates after RP were investigated from overall cases. The PSM rates based on types of surgery were obtained and calculated through subgroup analysis. In addition, the estimated rates of PSM according to grade group and pT stages were investigated. We compared various characteristics, including age, PSA, lymphovascular invasion, perineural invasion, lymph node metastasis, extraprostatic extension, and biochemical recurrence between patients with PSM and NSM. In this meta-analysis, among fixed and random effect models, interpretation was made using the values of a random-effects model. Heterogeneity between eligible studies was assessed using Q and I2 statistics and presented using p-values. In addition, the sensitivity analysis was conducted to assess the heterogeneity of eligible studies and the impact of each study on the combined effect. Statistical significances between subgroups were evaluated through a meta-regression test. To consider the publication bias, Egger’s test was used. If significant publication bias was found, the fail-safe N and trim-fill tests were performed to confirm the degree of publication bias. p-value < 0.05 was considered significant.

3. Results

3.1. Selection and Characteristics of Studies

A total of 436 studies were identified in the database, searching for the meta-analysis. Finally, 59 studies were selected according to the inclusion and exclusion criteria. Among the searched studies, 300 studies were excluded due to a lack of sufficient information. In addition, 75 reports were excluded due to being articles in a language other than English (n = 39) and non-original articles (n = 36). Two remaining reports were excluded as they focused on other diseases (Figure 1). The characteristics of the eligible studies are shown in Table 1.

3.2. The Positive Surgical Margin Rates after Radical Prostatectomy

The PSM rates ranged from 6.2 to 71.5% in the eligible studies. The estimated rate of PSM after RP was 25.3% (95% CI 21.9–29.0%) (Table 2). The robot-assisted RP subgroup showed 26.0% (95% CI 21.5–31.1%) the PSM rate. The PSM rates were 28.0% (95% CI 20.2–37.5%) and 30.1% (95% CI 26.8–33.6%) in nerve-sparing and non-nerve-sparing subgroups, respectively. Cases with the intraoperative frozen section showed 19.3% (95% CI 12.2–29.1%). However, the PSM rate of cases without the intraoperative frozen section was 29.5% (95% CI 23.4–36.3%).
PSM rates were 10.0% (95% CI 6.8–14.6%), 17.6% (95% CI 9.3–30.8%), 24.1% (95% CI 11.9–42.8%), 21.6% (95% CI 19.7–38.8%), and 36.2% (95% CI 11.3–71.7%) in grade groups 1, 2, 3, 4, and 5, respectively (Table 3). In a subgroup analysis based on pT stage, PSM rates were 13.5% (95% CI 10.2–17.7%), 41.4% (95% CI 33.4–49.8%), and 65.1% (95% CI 32.6–87.8%) in pT2, pT3, and pT3 stages, respectively. The multifocality of PSM was estimated at 30.9% (95% CI 22.9–40.1%). The apical PSM rate was 28.9% (95% CI 23.1–35.5%) after RP.

3.3. Comparison of Clinicopathological Characteristics between PSM and NSM

Next, the clinicopathological characteristics were compared between PSM and NSM. The mean PSA levels of PSM and NSM were 9.190 (95% CI 8.284–10.095) and 7.360 (95% CI 6.927–7.793), respectively (Table 4). There was a significant difference in mean PSA level between PSM and NSM (p < 0.001 in a meta-regression test). In addition, the lymphovascular invasion was significantly higher in the PSM subgroup than in the NSM subgroup (36.8%, 95% CI 29.4–45.0% vs. 25.6%, 95% CI 23.1–28.3%). Rates of lymph node metastasis were 9.7% (95% CI 5.9–15.6%) and 2.3% (95% CI 1.1–4.7%) in PSM and NSM subgroups, respectively. Extraprostatic extension was more frequently found in the PSM subgroup than in the NSM subgroup (63.9%, 95% CI 52.0–74.3% vs. 23.2%, 95% CI 15.0–34.1%; p < 0.001 in a meta-regression test). However, there was no significant difference in the patient’s age and perineural invasion between PSM and NSM.

3.4. Comparison of Biochemical Recurrence and Biochemical Recurrence-Free Survival between PSM and NSM

Rates of biochemical recurrence (BCR) were 28.5% (95% CI 21.4–36.9%) and 11.8% (95% CI 8.1–16.9%) in the PSM and NSM subgroups, respectively. There was a significant difference in BCR between the PSM and NSM subgroups (p < 0.001 in a meta-regression test). Comparing BCR-free survival, the PSM subgroup had a worse BCR-free survival rate than the NSM subgroup (hazard ratio 2.368, 95% CI 2.043–2.744; Figure 2).

4. Discussion

RP is the most common treatment option for localized prostatic cancers [75,76]. Microscopic examination of the RP specimen is performed for the entire prostate, including Gleason’s score, tumor extension, and surgical resection margin. After RP specimens, the presence of PSM is an important factor in predicting BCR and BCR-free survival [7,24,27,29,31,32,35,37,38,40,59,66,68]. However, in localized prostate cancer with PSM, the management after RP remains controversial [62]. If PSM is highly suggestive in the preoperative evaluation, it will be useful in establishing a treatment strategy and a postoperative follow-up. Previous studies have reported the correlation between PSM and clinicopathological characteristics by evaluating patients who underwent RP [7,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73]. However, the conclusive information from the individual study is not fully understood. The present study is a meta-analysis to investigate the correlation between PSM and clinicopathological characteristics and BCR-free survival after RP.
In the previous studies, the PSM rate after RP had a wide range and was approximately 20% [62]. Radiologic examination may be the most effective tool for predicting PSM among preoperative evaluations. However, the prediction of PSM in preoperative evaluations is limited in daily practice. In the present meta-analysis, the estimated PSM rate was 25.3% (95% CI 21.9–29.0%). This estimation resulted from simple integration. PSM was correlated with pT stage [77], BMI [78], serum PSA level [79], cancer percentage in biopsy specimens [80,81], prostate weight [82], and tumor volume [83]. In pathologic examination, the Gleason score is evaluated for the overall tumor, regardless of the tumor portion at PSM. So, the interpretation of the correlation between the grade group and PSM can be limited. Coelho et al. [84] suggested that the clinical stage was the only independent factor for predicting PSM. Although previous studies have reported the predicting factors of PSM, the integrative evaluation is limited by various populations and surgical methods. Therefore, a meta-analysis is more appropriate for obtaining detailed information. In addition, to obtain the detailed information, an additional subgroup analysis was needed. As expected, the PSM rate was significantly correlated with the higher grade group and pT stage in the present meta-analysis.
In the present study, clinicopathological characteristics were compared between patients with PSM and NSM. Patients with PSM had more frequent lymphovascular invasion than those with NSM. In addition, the rate of lymph node metastasis was significantly higher in the PSM subgroup than in the NSM subgroup. In cases with PSM, a precise microscopic examination is needed to detect the lymphovascular invasion because of hidden lymph nodes and distant metastasis. In addition, the comparison of BCR and BCR-free survival between PSM with and without lymphovascular invasion is needed. Porten et al. reported that tumor volume was associated with PSM [85]. Since tumor volume is associated with PSA level, the evaluation for the difference in PSA is needed. Patients with PSM had higher PSA levels than those with NSM (9.190 vs. 7.360). However, there were no significant differences in age and perineural invasion between PSM and NSM subgroups. These factors, age, and perineural invasion, are included in the characteristics of prostate cancer.
In eligible studies, BCR rates ranged from 10.7 to 46.0% in PC with PSM [21,24,28,29,37,38,53,67,73]. BCR was significantly correlated with the Gleason score, preoperative PSA, and pathologic stage [75]. BCR was significantly higher in cases with PSM than in cases with NSM (28.5 vs. 11.8%). In addition, patients with PSM showed a worse BCR-free survival than those with NSM (HR 2.368, 95% CI 2.043–2.744). Some report that there was no correlation between PSM and cancer-specific survival in long-term follow-up [86,87]. Chapin et al. reported that tumor location was not associated with BCR [75]. In our results, PSM at the apex was detected in 28.9% of overall PSM. However, the PSM rate could not be obtained by other tumor locations due to insufficient information. Further evaluation is needed on the impact of tumor location on BCR and BCR survival.
Recently, the application of robot-assisted RP has been increased in localized prostatic cancers. Previous studies have reported that PSM rates were low in robot-assisted RP specimens [62]. Robot-assisted RP showed a slightly low PSM rate compared to other RPs. However, there was no significant difference in PSM rate in a meta-regression test (p = 0.688). Nerve-sparing surgery can be applied to diminish complications after RP. However, because the neurovascular bundles are anatomically located adjacent to the prostate, the possibility of increasing PSM is present [56]. In the previous systematic review and meta-analysis, nerve-sparing surgery was not correlated with an increased risk of PSM in patients with pT2 tumors [88]. Interestingly, the risk of PSM increased in the pT3 stage with nerve-sparing surgery [88]. In the present study, the PSM rate was lower in the subgroup with nerve-sparing RP than in the subgroup without nerve-sparing RP (28.0 vs. 30.1%). This is probably because the non-nerve-sparing subgroup is more likely to have worse oncological factors such as tumor burden or high PSA levels, compared to the nerve-sparing subgroup. Therefore, despite the difference in the surgical method, it is believed that the PSM rate was lower in the nerve-sparing subgroup. We additionally performed a detailed analysis of the impact of the nerve-sparing technique on PSM based on the pT stage. However, unlike the previous study, there was no significant difference in PSM rate by application of the nerve-sparing technique in the same pT stage (data not shown). Theoretically, the impact of the intraoperative frozen section on reducing PSM rate is important. The rate of PSM was lower in the subgroup with the intraoperative frozen section than in the subgroup without the intraoperative frozen section (19.3 vs. 29.5%). However, a meta-regression test could not be performed due to an insufficient number of studies. Although the surgical resection margin is actually negative, PSM is detected by loss or cauterization of periprostatic tissue in the pathological examination. In addition, tumor locations, including lateral locations, can be considered.
This study has some limitations. First, the impact of the length of PSM could not be investigated due to insufficient information. The evaluation of the length of involved PSM is recommended in the pathological examination for RP specimens [89]. Second, an additional analysis for the correlation with tumor multifocality, location, and volume is needed.

5. Conclusions

PSM was significantly correlated with frequent lymphovascular invasion, lymph node metastasis, BCR, and BCR-free survival. Patients with higher grade group and pT stage showed frequent PSM. Grade group and tumor stage in preoperative evaluations can be useful for predicting PSM. In addition, evaluating PSM will help establish a careful strategy for RP and postoperative follow-up observation.

Author Contributions

Conceptualization, M.K., D.Y. and W.C.; methodology, J.P.; software, J.P.; validation, M.K., D.Y., J.P. and W.C.; formal analysis, J.P. and W.C.; investigation, M.K., D.Y. and W.C.; resources, M.K. and D.Y.; data curation M.K. and D.Y.; writing—original draft preparation, M.K. and D.Y.; writing—review and editing, W.C.; visualization, J.P.; supervision, W.C.; project administration, W.C.; funding acquisition, W.C. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by research funds from Chosun University, 2021.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The datasets generated during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare that they have no conflict of interest.

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Medicina 58 01251 g001 550
Figure 1. Flow chart.
Figure 1. Flow chart.
Medicina 58 01251 g001
Medicina 58 01251 g002 550
Figure 2. Forest plot for BCR-free survival between PSM and NSM (PSM: positive surgical margin; NSM: negative surgical margin; mPSM: multifocal PSM; uPSM: unifocal PSM; fPSM: focal PSM; nfPSM: non-single focal PSM) [7,24,26,27,29,31,32,35,37,38,40,41,48,53,59,66,68].
Figure 2. Forest plot for BCR-free survival between PSM and NSM (PSM: positive surgical margin; NSM: negative surgical margin; mPSM: multifocal PSM; uPSM: unifocal PSM; fPSM: focal PSM; nfPSM: non-single focal PSM) [7,24,26,27,29,31,32,35,37,38,40,41,48,53,59,66,68].
Medicina 58 01251 g002
Table
Table 1. Main characteristics of the eligible studies.
Table 1. Main characteristics of the eligible studies.
LocationOperationNo of Patient LocationOperationNo of Patients
TotalPSMTotalPSM
Albisinni 2018 [16]BelgiumMixed539127Poon 2000USANon-robot22064
Aminsharifi 2019 [17]USAND40731490Porcaro 2018ItalyMixed476327
Bianco 2003 [18]USANon-robot555178Poulakis 2006GermanyNon-robot18231
Cangiano 1999 [19]USANon-robot30172Preisser 2019 (a)GermanyMixed8770579
Cannon 2005 [20]USANon-robot40225Preisser 2019 (b)GermanyMixed346*
Ceylan 2016 [21]TurkeyNon-robot13093Preston 2015CanadaMixed6120848
Dai 2019 [22]ChinaMixed531160Rabbani 1998USANon-robot24185
Eastham 2007 [23]USANon-robot2442275Rosen 1992USANon-robot14433
Furubayashi 2014 [24]JapanND27556Sachdeva 2017UKMixed592181
Ginzburg 2012 [25]USARobot-assisted1159316Salomon 2003USANon-robot37166
Golabek 2014 [26]PolandNon-robot29586Sayyid 2017USARobot-assisted20048
Hashine 2012 [27]JapanNon-robot505194Soeterik 2020NetherlandsRobot-assisted2574844
Hollemans 2020 [28]NetherlandsND835284Soulié 2001FranceNon-robot21271
Jo 2017 [29]KoreaRobot-assisted815270Stephenson 1997USANon-robot537
Jones 1990 [30]CanadaNon-robot19992Takahara 2019JapanRobot-assisted23052
Kang 2017 [31]KoreaND1600760Tan 2019USA,
Puerto Rico		Mixed45,4264522
Keller 2019 [7]SwitzerlandRobot-assisted973315Tatsugami 2017JapanRobot-assisted3469916
Kim 2018 [32]KoreaMixed46150Tian 2019ChinaNon-robot418142
Koizumi 2018 [33]JapanMixed45064Trabulsi 2009USARobot-assisted24038
Konety 2004 [34]USANon-robot338van den Ouden
1993		NetherlandsNon-robot17256
Lee 2016 [35]KoreaND1733473Villers 2000USAND400111
Menard 2008 [36]FranceNon-robot640180Vis 2006NetherlandsND28166
Meyer 2017 [37]GermanyND903118Volavšek 2018NDND10729
Mitsuzuka 2015 [38]JapanNon-robot 1268307Ward 2004USAND72682103
Miyake 2010 [39]JapanNon-robot12714Weldon 1995USANon-robot20088
Pak 2019 [40]KoreaND2013404Wu 2019USAND2796476
Palisaar 2005 [41]GermanyND1343264Yamada 2020JapanRobot-assisted614144
Park 2003 [42]USANon-robot22143Yu 2018KoreaMixed3324461
Park 2018 [43]KoreaMixed546179Yuksel 2017TurkeyMixed14046
Partin 1993 [44]USANon-robot10750
No, number; PSM, positive surgical margin. *, included duplicated patients [7,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44].
Table
Table 2. The estimated rates of positive surgical margin after radical prostatectomy in prostatic cancers.
Table 2. The estimated rates of positive surgical margin after radical prostatectomy in prostatic cancers.
Number
of
Subsets		Fixed Effect
[95% CI, %]		Heterogeneity Test
[p-Value]		Random Effect
[95% CI, %]		Egger’s
Test
[p-Value]		Meta-Regression Test
[p-Value]
Overall5820.2 [19.9, 20.5]<0.00125.3 [21,9, 29.0]0.005
 Robot-assisted1226.9 [26.1, 27.7]<0.00126.0 [21.5, 31.1]0.7260.688 *
 Others2826.5 [25.6, 27.4]<0.00127.2 [222, 32.7]0.471
 Nerve-sparing1124.5 [23.7, 25.2]<0.00128.0 [202, 37.5]0.6610.580 †
 Non-nerve-sparing829.4 [28.4, 30.5]<0.00130.1 [268, 33.6]0.753
 Intraoperative frozen219.1 [14.7, 24.5]0.08719.3 [122, 29.1]0.077-
 Non-intraoperative frozen129.5 [23.4, 36.3]1.00029.5 [234, 36.3]-
CI: confidence interval. * Comparison between robot-assisted and other radical prostatectomy. † Comparison between nerve-sparing and non-nerve-sparing radical prostatectomy.
Table
Table 3. Detailed analysis of the estimated rates of positive surgical margin after radical prostatectomy in prostatic cancers.
Table 3. Detailed analysis of the estimated rates of positive surgical margin after radical prostatectomy in prostatic cancers.
Number
of
Subsets		Fixed Effect
[95% CI, %]		Heterogeneity Test
[p-Value]		Random Effect
[95% CI, %]		Egger’s
Test
[p-Value]		Meta-Regression Test
[p-Value]
Grade group
 GG1 (Gleason score ≤6)108.2 [7.8, 8.6]<0.00110.0 [6.8, 14.6]0.535Ref.
 GG2 (Gleason score 3 + 4)717.4 [16.1, 18.8]<0.00117.6 [9.3, 30.8]0.9180.100
 GG3 (Gleason score 4 + 3)622.7 [20.3, 25.3]<0.00124.1 [11.9, 42.8]0.9950.010
 GG4/5 (Gleason score ≥8)815.5 [14.4, 16.6]<0.00126.8 [16.8, 40.1]0.0780.001
  GG4 (Gleason score 8)413.0 [11.8, 14.3]<0.00121.6 [10.7, 38.8]0.2300.036
  GG5 (Gleason score 9/10)417.5 [15.0, 20.2]<0.00136.2 [11.3, 71.7]0.3070.001
pT stage
 pT21713.8 [13.2, 14.5]<0.00113.5 [10.2, 17.7]0.991Ref.
 pT31534.5 [33.2, 35.7]<0.00141.4 [33.4, 49.8]0.119<0.001
 pT4365.1 [32.6, 87.8]0.56165.1 [32.6, 87.8]0.0640.002
Multifocal PSM rate1029.0 [27.3, 30.8]<0.00130.9 [22.9, 40.1]0.370
Apical PSM rate1125.0 [238.0, 263.0]<0.001289 [231.0, 355.0]0.173
CI: confidence interval; PSM: positive surgical margin; Ref: reference.
Table
Table 4. Comparisons of clinicopathological parameters between positive and negative surgical margins after radical prostatectomy in prostatic cancers.
Table 4. Comparisons of clinicopathological parameters between positive and negative surgical margins after radical prostatectomy in prostatic cancers.
Number
of
Subsets		Fixed Effect
[95% CI]		Heterogeneity Test
[p-Value]		Random Effect
[95% CI]		Egger’s
Test
[p-Value]		Meta-Regression Test
[p-Value]
Age (years)
PSM1264.427 [64.341, 64.514]<0.00164.291 [63.149, 65.432]0.7870.970
NSM963.492 [63.459, 63.523]<0.00164.273 [63.081, 65.465]0.416
PSA (ng/mL)
PSM108.368 [8.312, 8.425]<0.0019.190 [8.284, 10.095]0.234<0.001
NSM86.867 [6.853, 6.881]<0.0017.360 [6.927, 7.793]0.424
Lymphovascular invasion (%)
PSM236.8 [29.4, 45.0]0.47036.8 [29.4, 45.0]-0.005
NSM225.6 [23.1, 28.3]0.71025.6 [23.1, 28.3]-
Perineural invasion (%)
PSM324.5 [17.0, 33.9]<0.00141.2 [8.7, 83.7]0.4830.997
NSM227.6 [20.8, 35.7]<0.00141.7 [4.5, 91.5]-
Lymph node metastasis (%)
PSM69.1 [7.4, 11.3]0.0019.7 [5.9, 15.6]0.745<0.001
NSM63.8 [3.2, 4.6]<0.0012.3 [1.1, 4.7]0.168
Extraprostatic extension (%)
PSM361.7 [57.5, 65.7]0.00963.9 [52.0, 74.3]0.413<0.001
NSM326.6 [25.0, 28.3]<0.00123.2 [15.0, 34.1]0.620
Biochemical recurrence (%)
PSM935.5 [32.9, 38.2]<0.00128.5 [21.4, 36.9]0.034<0.001
NSM711.5 [10.4, 12.8]<0.00111.8 [8.1, 16.9]0.991
CI: confidence interval; PSM: positive surgical margin; NSM: negative surgical margin.
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Kim, M.; Yoo, D.; Pyo, J.; Cho, W. Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis. Medicina 2022, 58, 1251. https://doi.org/10.3390/medicina58091251

AMA Style

Kim M, Yoo D, Pyo J, Cho W. Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis. Medicina. 2022; 58(9):1251. https://doi.org/10.3390/medicina58091251

Chicago/Turabian Style

Kim, Minseok, Daeseon Yoo, Jungsoo Pyo, and Wonjin Cho. 2022. "Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis" Medicina 58, no. 9: 1251. https://doi.org/10.3390/medicina58091251

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