Athul John, Thomas Milton, Aashray Gupta, Mau T Nguyen, Brandon Stretton, Joseph Hewitt, James Virgin, Joshua Kovoor, Rick Catterwell, Luke Selth, Michael O Callaghan
{"title":"根治性前列腺切除术后阳性手术切缘位置的影响：一项网络荟萃分析。","authors":"Athul John, Thomas Milton, Aashray Gupta, Mau T Nguyen, Brandon Stretton, Joseph Hewitt, James Virgin, Joshua Kovoor, Rick Catterwell, Luke Selth, Michael O Callaghan","doi":"10.1007/s00345-025-05479-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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<sup>2</sup> = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I<sup>2</sup> = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I<sup>2</sup> = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I<sup>2</sup> = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I<sup>2</sup> = 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<sup>2</sup> = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I<sup>2</sup> = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I<sup>2</sup> = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).</p><p><strong>Conclusions: </strong>The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"134"},"PeriodicalIF":2.8000,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846713/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of positive surgical margin location after radical prostatectomy: a network meta-analysis.\",\"authors\":\"Athul John, Thomas Milton, Aashray Gupta, Mau T Nguyen, Brandon Stretton, Joseph Hewitt, James Virgin, Joshua Kovoor, Rick Catterwell, Luke Selth, Michael O Callaghan\",\"doi\":\"10.1007/s00345-025-05479-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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<sup>2</sup> = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I<sup>2</sup> = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I<sup>2</sup> = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I<sup>2</sup> = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I<sup>2</sup> = 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<sup>2</sup> = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I<sup>2</sup> = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I<sup>2</sup> = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).</p><p><strong>Conclusions: </strong>The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.</p>\",\"PeriodicalId\":23954,\"journal\":{\"name\":\"World Journal of Urology\",\"volume\":\"43 1\",\"pages\":\"134\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-02-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846713/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00345-025-05479-7\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00345-025-05479-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Impact of positive surgical margin location after radical prostatectomy: a network meta-analysis.
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, I2 = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I2 = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I2 = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I2 = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I2 = 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, I2 = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I2 = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I2 = 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.
期刊介绍：
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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