The impact of surgical margin status on prostate cancer-specific mortality after radical prostatectomy: a systematic review and meta-analysis

Background Until now, there is no clear conclusion on the relationship between the surgical margin status after radical prostatectomy (RP) and prostate cancer-specific mortality (PCSM). Therefore, we conducted this systematic review and meta-analysis based on all eligible case-control studies. Methods A systematic and comprehensive literature search was performed based on PUBMED and EMBASE to identify all of the potentially relevant publications which were published before September 2019. Hazard ratio (HR) for PCSM was independently extracted by two reviewers from all eligible studies. Pooled HR estimates with their corresponding 95% confidence intervals (95% CIs) were computed by Stata12.0. Results Total 15 eligible studies were included in this meta-analysis. The pooled results showed that patients with positive surgical margin (PSM) after RP may have higher PCSM than those who had a negative surgical margin (HR 1.44, P = 0.043). In the subgroup analysis, we found that no matter whether the pathological stage of the patients is T2 or T3, PSM is indicative of a high PCSM and that the PCSM of T3 is higher than T2 (Pathological stage T3, HR 1.77, P = 0.032; Pathological stage T2, HR 1.56, P = 0.003). In addition, by performing the subgroup analysis of Gleason score, we concluded that both Gleason score 8-10 and Gleason score <= 7 would increase the risk of PCSM, and the former was more significant than the latter (Gleason score 8-10, HR 1.88, P < 0.001; Gleason score <= 7, HR 1.38, P = 0.039). Moreover, PSM increased PCSM regardless of whether the patients received radiation therapy or not (radiation therapy, HR 1.92, P < 0.001; no radiation therapy, HR 1.42, P < 0.001). Conclusions This meta-analysis demonstrated that patients with PSM after RP may have an elevated PCSM. However, to evaluate these correlations in more details, it is necessary to conduct further studies on a larger sample size.