RESUMO
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.
Assuntos
Margens de Excisão , Prostatectomia , Neoplasias da Próstata/cirurgia , Humanos , Masculino , Neoplasias da Próstata/mortalidade , Viés de PublicaçãoRESUMO
Abstract Introduction Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. Objectives The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. Methods Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. Results Margin status is related to recurrence rate in both groups (p < 0.05) without significant differences between open and laser cordectomy (p > 0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p > 0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p < 0.05). Conclusions Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.
Resumo Introdução Cordectomia por laringofissura e cirurgia transoral a laser têm sido propostas para o tratamento do câncer glótico inicial. Objetivos O objetivo desse estudo retrospectivo foi avaliar o valor prognóstico do estado da margem em 162 casos consecutivos de carcinoma glótico inicial (Tis-T1) tratado com cirurgia endoscópica a laser de CO2 (Grupo A) ou cordectomia por laringofissura (Grupo B) e comparar resultados oncológicos e funcionais. Método Foram analisados fatores prognósticos clínicos, taxa de recorrência local de acordo com o estado da margem, sobrevida global e sobrevida livre de doença. Resultados O estado de margem está relacionado à taxa de recorrência em ambos os grupos (p < 0,05) sem diferenças significativas entre cordectomia aberta e cirurgia a laser (p > 0,05). A sobrevida global de cinco anos e a sobrevida livre de doença foram, respectivamente, 90,48% e 85,71% no Grupo A; 88,14% e 86,44% no Grupo B (p > 0,05). Menor taxa de traqueostomia, recuperação mais rápida da função de deglutição e menor tempo de internação foram observados no Grupo A (p < 0,05). Conclusões O estado da margem tem papel prognóstico no câncer glótico T1a-T1b. A cirurgia a laser transoral mostrou resultados oncológicos semelhantes aos da cordectomia aberta, com melhores resultados funcionais.
RESUMO
INTRODUCTION: Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. OBJECTIVES: The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. METHODS: Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. RESULTS: Margin status is related to recurrence rate in both groups (p<0.05) without significant differences between open and laser cordectomy (p>0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p>0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p<0.05). CONCLUSIONS: Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.