Abstract | OBJECTIVES: To systematically review and perform a meta-analysis of studies investigating the role of primary Gleason grade ( PGG), Gleason score (GS) or Gleason grade group (GGG) at positive surgical margins (PSMs) after radical prostatectomy (RP) in predicting biochemical recurrence (BCR) and oncological outcomes. METHODS: A systematic search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis ( PRISMA) guidelines. Studies published between 2005 and 2019 were included. The quality of the studies selected was assessed, and a protocol was registered and published in advance (PROSPERO: CRD42019131800). The primary outcome measure was BCR. Secondary outcome measures included cancer-specific survival, metastasis-free survival and overall mortality during the follow-up period. RESULTS: Our systematic search yielded 3116 unique results. Ten studies were selected for meta-analysis. The sample sizes of PSM cohorts varied from 200 to 956, while the median follow-up ranged from 1.5 to 13 years. Most studies used BCR as a surrogate marker for disease progression; only two studies reported other oncological outcomes. Meta-analysis was performed in selected groups ( PGG, GS and GGG). PGG 4 or 5 at the PSM was found to be predictive of BCR (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.37-2.02; P < 0.01). GGG > 1 at margin was also predictive of BCR compared to GGG 1 (GGG 1 vs 2: HR 2.35, 95% CI 1.6 -3.46; P < 0.001; GGG 1 vs 3: HR 3.95, 95% CI 1.82-8.57; P = 0.005; GGG 1 vs 4: HR 7.17, 95% CI 1.76-29.17; P = 0.006; and GGG 1 vs 5: HR 12.37, 95% CI 1.80-84.82; P = 0.01). CONCLUSION: Gleason score, PGG and GGG at the PSM are associated with a significantly increased risk of BCR. Longer-term studies are needed to investigate the utility of PGG, GS or GGG at the PSM in their ability to predict not only BCR but other outcomes such as cancer-specific survival, metastasis-free survival and overall survival.
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Authors | Athul John, Hritik John, Rick Catterwell, Luke A Selth, Michael O Callaghan |
Journal | BJU international
(BJU Int)
Vol. 127 Suppl 1
Pg. 13-22
(05 2021)
ISSN: 1464-410X [Electronic] England |
PMID | 33973331
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
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Copyright | © 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd. |
Chemical References |
- Prostate-Specific Antigen
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Topics |
- Disease Progression
- Humans
- Male
- Margins of Excision
- Neoplasm Grading
- Neoplasm Recurrence, Local
(blood, pathology)
- Neoplasm, Residual
- Prostate-Specific Antigen
(blood)
- Prostatectomy
- Prostatic Neoplasms
(blood, pathology, surgery)
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