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Meta-Analysis
. 2017 Jul-Aug;19(4):493-499.
doi: 10.4103/1008-682X.179531.

Factors influencing biochemical recurrence in patients who have received salvage radiotherapy after radical prostatectomy: a systematic review and meta-analysis

Zhong-Wei Jia  1   2 , Kun Chang  1   2 , Bo Dai  1   2 , Yun-Yi Kong  2   3 , Yue Wang  1   2 , Yuan-Yuan Qu  1   2 , Yi-Ping Zhu  1   2 , Ding-Wei Ye  1   2
Affiliations
Meta-Analysis

Factors influencing biochemical recurrence in patients who have received salvage radiotherapy after radical prostatectomy: a systematic review and meta-analysis

Zhong-Wei Jia et al. Asian J Androl. 2017 Jul-Aug.

Abstract

Several studies have evaluated the risk factors influencing biochemical recurrence (BCR) of prostate cancer in patients receiving salvage radiotherapy (SRT) for BCR after radical prostatectomy (RP), but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases: PubMed, Embase, and Web of Science using the following terms in "All fields": "salvage radiation therapy," "salvage IMRT," "S-IMRT," "salvage radiotherapy," "SRT," "radical prostatectomy," "RP," "biochemical recurrence," "BCR," "biochemical relapse." Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score (GS) ≥7 (odds ratio [OR]: 3.82; 95% confidence interval [CI]: 2.60-5.64) and pathological tumor (pT) stage ≥3a (OR: 1.82; 95% CI: 1.36-2.42) were positively correlated with BCR. However, SRT combined with androgen deprivation therapy (ADT) (OR: 0.63; 95% CI: 0.44-0.90) and radiation therapy (RT) dose ≥64 Gy (OR: 0.35; 95% CI: 0.19-0.64) were negatively correlated with BCR. Perineural invasion (OR: 2.64; 95% CI: 1.11-6.26), preoperative prostate-specific antigen (PSA) ≥10 ng ml-1 (OR: 1.36; 95% CI: 0.94-1.96), positive surgical margin (OR: 0.92; 95% CI: 0.7-1.19), and seminal vesicle involvement (SVI) (OR: 1.09; 95% CI: 0.83-1.43) had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.

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Figures

Figure 1
Figure 1
Flow chart of papers retrieved and excluded.
Figure 2
Figure 2
Forest plot of the studies assessing the association between preoperative PSA and BCR. PSA: prostate-specific antigen; BCR: biochemical recurrence.
Figure 3
Figure 3
Forest plot of the studies assessing the association between GS and BCR. GS: Gleason score; BCR: biochemical recurrence.
Figure 4
Figure 4
Forest plot of the studies assessing the association between pT stage and BCR. pT: pathological tumor; BCR: biochemical recurrence.
Figure 5
Figure 5
Forest plot of the studies assessing the association between surgical margins and BCR. BCR: biochemical recurrence.
Figure 6
Figure 6
Forest plot of the studies assessing the association between SRT combined with ADT or not and BCR. SRT: salvage radiotherapy; ADT: androgen deprivation therapy; BCR: biochemical recurrence.
Figure 7
Figure 7
Forest plot of the studies assessing the association between radiation dose and BCR. BCR: biochemical recurrence.
Figure 8
Figure 8
Forest plot of the studies assessing the association between perineural invasion and BCR. BCR: biochemical recurrence.
Figure 9
Figure 9
Forest plot of the studies assessing the association between SVI and BCR. SVI: seminal vesicle involvement; BCR: biochemical recurrence.
Figure 10
Figure 10
Funnel plot and Egger's test to assess the publication bias.
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