TY - JOUR
T1 - Impact of positive surgical margin location after radical prostatectomy
T2 - a network meta-analysis
AU - John, Athul
AU - Milton, Thomas
AU - Gupta, Aashray
AU - Nguyen, Mau T.
AU - Stretton, Brandon
AU - Hewitt, Joseph
AU - Virgin, James
AU - Kovoor, Joshua
AU - Catterwell, Rick
AU - Selth, Luke
AU - Callaghan, Michael O.
PY - 2025/2/22
Y1 - 2025/2/22
N2 - 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.
AB - 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.
KW - Biochemical recurrence
KW - Positive surgical margin
KW - Positive surgical margin location
KW - Prostate cancer
KW - Radical prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=85218703920&partnerID=8YFLogxK
U2 - 10.1007/s00345-025-05479-7
DO - 10.1007/s00345-025-05479-7
M3 - Review article
AN - SCOPUS:85218703920
SN - 0724-4983
VL - 43
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
M1 - 134
ER -
