Background
Methods
Literature search
Inclusion and exclusion criteria
Data extraction and quality assessment
Author | Year | Country | No. of patients | Recruitment period | Age (years) | p-PSA (ng/ml) | Follow-up (months) | Surgical approach |
---|---|---|---|---|---|---|---|---|
Wettstein et al. [35] | 2017 | Switzerland | 371 | 2008–2015 | Median (range) 63 (41–78) | Median (range) 6.79 (0.43–81.4) | Median (range) 28 (1–64) | NA |
Xun et al. [6] | 2017 | China | 172 | 2003–2014 | Median (IQR) 68 (62–72) | Median (IQR) 16.1 (10.9–28.3) | Median (IQR) 46.4 (33.4–62.4) | NA |
Meyer et al. [36] | 2017 | Germany | 903 | 1992–2005 | Median (IQR) 63 (59–66) | Median (IQR) 6.4 (4.6–9.0) | Median (IQR) 133 (97–157) | NA |
Gandaglia et al. [37] | 2017 | Multi-centred | 94 | 2011–2015 | Median (IQR) 64.3 (57.1–68.9) | Median (IQR) 9.7 (5.1–17.5) | Median (IQR) 23.5 (18.7–27.3) | Robot-assisted RP |
Shangguan et al. [33] | 2016 | China | 172 | 2003–2014 | Median (range) 68 (62–72) | Median (range) 16.1 (10.9–28.3) | Median (IQR) 46.4 (33.4–62.4) | Open and laparoscopic RP |
Zhang et al. [34] | 2016 | China | 168 | 2006–2011 | Median (range) 69 (53–85) | Median (range) 13.31 (4.59–36.12) | Median (range) 68 (7–98) | Laparoscopic RP |
Simon et al. [12] | 2016 | Multi-centres | 411 | 2001–2013 | Mean ± SD 61 ± 6.1 | NA | Median 63 | NA |
Sevcenco et al. [38] | 2016 | Multi-centres | 7205 | 2000–2011 | Median (IQR) 61 (57–66) | Median (IQR) 6 (4–9) | Median (IQR) 27 (19–48) | NA |
Pagano et al. [20] | 2016 | USA | 180 | 1990–2011 | Median (range) 63.7 (58.8–67.6) | Median (range) 9.1 (6.3–17.1) | Median (range) 26.7 (8.8–66) | NA |
Moschini et al. [39] | 2016 | USA | 1011 | 1987–2012 | NA | Median 12.0 | Median 211.2 | NA |
Mortezavi et al. [40] | 2016 | Switzerland | 100 | 1999–2007 | Mean ± SD 63.5 ± 6.5 | Mean ± SD 9.6 ± 8.3 | Median (range) 126 (60–176) | Laparoscopic RP |
Mao et al. [41] | 2016 | China | 106 | 2008–2009 | Mean (range) 68.1 (48–83) | Mean (range) 25.1 (3.1–104.3) | Median (range) 69 (8–84) | Laparoscopic RP |
Whalen et al. [29] | 2015 | USA | 609 | 2005–2011 | Mean ± SD 61.2 ± 7.3 | Mean ± SD 6.8 ± 6.3 | Median (range) 20.5 (1–80) | NA |
Song et al. [42] | 2015 | Korea | 2137 | 1988–2011 | Median (IQR) 67 (63–71) | Median (IQR) 6.9 (4.7–11.2) | Mean (range) 39.4 (8–1834) | NA |
Reeves et al. [43] | 2015 | Australia | 1479 | 2005–2012 | Median 62 | NA | Median 14 | NA |
Hashimoto et al. [5] | 2015 | Japan | 837 | 2006–2013 | Median (range) 65 (39–78) | Median (range) 6.9 (3–47.4) | Median (range) 20.5 (1.3–91.3) | Robot-assisted RP |
Alvin et al. [44] | 2015 | Singapore | 725 | 2003–2013 | Median (range) 62 (37–79) | Median (range) 7.9 (0.79–72.9) | Mean (range) 28.5 (6–116) | Robot-assisted RP |
Touijer et al. [13] | 2014 | USA | 369 | 1988–2010 | Median (IQR) 62 (57–66) | Median (IQR) 8 (5–15) | Median 48 | NA |
Ritch et al. [45] | 2014 | USA | 979 | 2003–2009 | Median 62 | NA | Median 47 | Open and robot-assisted RP |
Kang et al. [21] | 2014 | Korea | 3034 | 2004–2011 | Mean ± SD 65.9 ± 6.6 | Mean ± SD 11.6 ± 12.2 | Median 47 | NA |
Fairey et al. [14] | 2014 | USA | 229 | 1987–2008 | Median (range) 65 (41–83) | NA | Median (range) 174 (2.4–253.2) | NA |
Turker et al. [46] | 2013 | Turkey | 331 | 1993–2009 | Mean ± SD 62.79 ± 6.4 | Mean ± SD 11.1 ± 10.5 | Mean ± SD 29.7 ± 33.2 | NA |
Sammon et al. [10] | 2013 | USA | 794 | 1993–2010 | Mean ± SD 63.4 ± 8.1 | Mean ± SD 5.6 ± 3.6 | Median (IQR) 26.4(12.2–54.6) | NA |
Chen et al. [30] | 2013 | China | 152 | 2004–2011 | NA | NA | Median (range) 48 (12–87) | Laparoscopic RP |
Sooriakumaran et al. [11] | 2012 | Sweden | 944 | 2002–2006 | Median (IQR) 62.2 (58.2–65.8) | Median (IQR) 6.4(4.8–9.0) | Median (IQR) 75.6(67.2–86.4) | Robot-assisted RP |
Lu et al. [31] | 2012 | China | 894 | 1993–1999 | Median (IQR) 62 (57–66) | Median (IQR) 6.0 (4.5–8.6) | Median (IQR) 9.9 (6.1–11.3) | NA |
Iremashvili et al. [47] | 2012 | USA | 1444 | 2003–2010 | Mean (range) 61.3 (56–66.3) | Mean (range) 5.7 (4.5–8.0) | Median (range) 43.2 (3–216) | Open and robot-assisted RP |
Connolly et al. [48] | 2012 | Australia | 160 | 1988–1997 | Mean ± SD 63.1 ± 6.3 | Median (IQR) 9.95 (6.0–21.4) | Median (IQR) 26.2 (5.5–37.3) | Robot-assisted RP |
Busch et al. [49] | 2012 | Germany | 1845 | 1999–2007 | Mean ± SD 62.0 ± 5.9 | Median (range) 26.3 (17.0–42.1) | Median (range) 56 (0–35) | Laparoscopic RP |
Berge et al. [50] | 2012 | Norway | 577 | 2002–2008 | Mean (range) 61.5 (42–76) | Mean (range) 8.4 (0.3–31) | Median (range) 36 (3–72) | Laparoscopic RP |
Lee et al. [51] | 2011 | Korea | 1000 | 2003–2009 | Median (range) 66 (37–82) | Median (range) 7.8 (0.1–261.8) | Mean 39.4 | NA |
Alenda et al. [23] | 2011 | France | 1248 | 1998–2008 | Mean (range) 63 (44–78) | Mean (range) 10.9 (0.9–134) | Median 23.4 | NA |
Fukuhara et al. [52] | 2010 | Japan | 364 | 2000–2009 | Median (range) 66 (52–78) | Median (range) 8.1 (1.7–77.7) | Median (range) 33 (10–109) | NA |
Cho et al. [53] | 2010 | Korea | 171 | 2005–2009 | Mean (range) 64.4 (49–80) | NA | Mean (range) 23.3 (2–51) | NA |
Alkhateeb et al. [26] | 2010 | Canada | 1268 | 1992–2008 | Mean ± SD 62.0 ± 6.6 | Median (range) 6.2 (0.1–65.9) | Mean (range) 78.1 (3–192) | NA |
Jeon et al. [54] | 2009 | Korea | 237 | 1995–2004 | Mean (range) 64.5 (44–86) | Mean (range) 11.5 (0.2–98) | Median (range) 21.6 (2–88) | NA |
Schroeck et al. [55] | 2008 | USA | 3194 | 1988–2007 | Median (IQR) 62.6(57.2–67.9) | Median (IQR) 6.3(4.5–9.6) | Median 31.2 | NA |
Pavlovich et al. [56] | 2008 | USA | 508 | 2001–2005 | Mean ± SD 57.6 ± 6.7 | Mean (range) 6.0 (0.3–27) | Median (range) 12 (2–52) | Laparoscopic RP |
Hong et al. [57] | 2008 | Korea | 372 | 2003–2007 | Mean (range) 64.2 (37–72) | Mean (range) 8.7 (0.2–104.2) | NA | NA |
Cheng et al. [8] | 2005 | Indiana | 504 | 1990–1998 | Mean (range) 62 (34–80) | NA | Mean (range) 44 (1.5–144) | NA |
Shariat et al. [58] | 2004 | USA | 630 | 1994–2002 | Median (range) 60.9 (40–75) | Mean (range) 6.1 (0.1–99) | Median (range) 21.4 (1–101.3) | NA |
Author | Specimen GS ≦ 7/˃ 7 | Staging system | T stage 1–2/3–4 | SM+/ SM− | No. of BCR (%) | Definition of BCR |
---|---|---|---|---|---|---|
Wettstein et al. [35] | 292 /79 | WHO/ISUP 2016 | 263/108 | 133/238 | 49 (13.2%) | Rising and verified PSA levels > 0.1 ng/ml |
Xun et al. [6] | 131/41 | TNM 2002 | NA | 62/110 | 80 (46.5%) | The date of the first PSA elevated to 0.2 ng/ml |
Meyer et al. [36] | 879/24 | TNM 2002 | 903/0 | 37/206 | 137(15.2%) | PSA level of ≧ 0.2 ng/ml and rising after RP |
Gandaglia et al. [37] | 55/39 | TNM 2002 | 22/72 | 30/64 | 24 (25.5%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Shangguan et al. [33] | 131/41 | NA | NA | 62/110 | NA | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Zhang et al. [34] | 136/32 | TNM 2012 | NA | 30/138 | NA | First PSA elevated to 0.2 ng/ml |
Simon et al. [12] | 368/43 | NA | NA | 353/58 | 70 (17%) | Single PSA concentration of > 0.2, two concentrations at 0.2 ng/ml |
Sevcenco et al. [38] | 6645/560 | TNM 2009 | NA | 6137/1074 | 798 (11.1%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Pagano et al. [20] | 90/90 | TNM 2002 | NA | 74/106 | 120 (66.5%) | Two postoperative PSA values of ≧ 0.2 ng/ml |
Moschini et al. [39] | 647/364 | NA | 355/657 | 566/445 | 697 (69%) | PSA 0.4 ng/ml or greater |
Mortezavi et al. [40] | 86/14 | NA | 79/21 | 25/75 | 12 (12%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Mao et al. [41] | 78/28 | TNM 2002 | 63/43 | 20/86 | 31 (29.2%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Whalen et al. [29] | 516/93 | TNM 1997 | 435/174 | 483/126 | 73 (12%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Song et al. [42] | 1722/415 | NA | 1899/248 | 2132/13,433 | 466 (21.8%) | Greater than 0.2 ng/ml |
Reeves et al. [43] | 1306/142 | NA | 1042/454 | 390/1089 | 238 (20.5%) | Greater than 0.2 ng/ml |
Hashimoto et al. [5] | 634/373 | WHO 2004 | 677/160 | 243/594 | 102 (12.2%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Alvin et al. [44] | 663/58 | TNM 2010 | 497/228 | 311/414 | 104 (14%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Touijer et al. [13] | 184/185 | TNM 2010 | 46/323 | 138/231 | 201 (54%) | PSA ≧ 0.1 ng/ml with confirmatory rise |
Ritch et al. [45] | 783/196 | TNM 2002 | 955/24 | 335/644 | 317 (32.4%) | Greater than 0.2 ng/ml |
Kang et al. [21] | 2575/459 | TNM 2009 | NA | 974/2060 | NA | A serum PSA value of 0.4 ng/ml or greater after RP |
Fairey et al. [14] | 133/96 | TNM 2002 | 0/229 | 105/124 | 83 (36.2%) | Detectable PSA (ng/ml) followed by two consecutive confirmatory (1988–1994: PSA ≧ 0.3; 1995–2005: PSA ≧ 0.05; 2006–present: PSA ≧ 0.03) |
Turker et al. [46] | 167/164 | TNM 1994 | NA | 80/251 | 70 (21%) | Higher than 0.2 ng/ml on 2 separate measurements 1 month apart |
Sammon et al. [10] | 760/34 | AJCC 2002 | 592/202 | 162/632 | 107 (13.5%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Chen et al. [30] | 109/43 | NA | 0/152 | 27/125 | 80 (52.6%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Sooriakumaran et al. [11] | 900/44 | NA | 651/230 | 194/704 | 135 (15.2%) | Greater than 0.2 ng/ml |
Lu et al. [31] | 796/98 | TNM 2010 | 703/191 | 250/644 | 277 (31%) | PSA ≧ 0.1 ng/ml with confirmatory rise |
Iremashvili et al. [47] | 1286/258 | NA | NA | 479/965 | 210 (15%) | Greater than 0.2 ng/ml |
Connolly et al. [48] | 95/65 | NA | 65/95 | 60/100 | 88 (55%) | Greater than 0.2 ng/ml |
Busch et al. [49] | 1538/307 | NA | 1802/9 | 537/1308 | 450 (24.4%) | PSA ≧ 0.1 ng/ml with confirmatory rise |
Berge et al. [50] | 553/24 | TNM 2002 | 441/136 | 168/409 | 91 (16%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Lee et al. [51] | 236/764 | NA | NA | 337/663 | 99 (9.9%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Alenda et al. [23] | 1248/0 | NA | NA | 400/843 | 176 (16.9%) | PSA > 0.2 ng/mL |
Fukuhara et al. [52] | 332/32 | TNM 2002 | 275/89 | 157/207 | 66 (18.1%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Cho et al. [53] | 153/14 | TNM 2002 | 126/45 | 58/109 | 15 (8.8%) | A serum PSA value of 0.4 ng/ml or greater after RP |
Alkhateeb et al. [26] | 1159/109 | NA | 853/415 | 264/1004 | NA | A serum PSA value of 0.4 ng/ml or greater after RP |
Jeon et al. [54] | 190/45 | TNM 2002 | 145/92 | 86/151 | 67 (28.3%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Schroeck et al. [55] | 2855/359 | NA | 1991/1166 | 982/2212 | 706 (25.7%) | Greater than 0.2 ng/ml |
Pavlovich et al. [56] | 494/14 | TNM 2002 | 416/92 | 69/439 | 102 (20%) | Two consecutive increases in PSA ≧ 0.2 ng/ml |
Hong et al. [57] | 361/11 | TNM 2002 | 371/0 | 46/326 | NA | First value greater than 0.2 ng/ml |
Cheng et al. [8] | 410/94 | TNM 1997 | 348/156 | 174/330 | 157 (21.2%) | Two consecutive increases in PSA ≧ 0.1 ng/ml |
Shariat et al. [58] | 565/65 | TNM 1997 | NA | 179/451 | 80 (12.7%) | First value greater than 0.2 ng/ml |
Statistical analyses
Results
Literature search and study characteristics
Meta-analysis
Analysis specification | No. of studies | Study heterogeneity | Effects model | Pooled HR (95% CI) | p value | |
---|---|---|---|---|---|---|
I2 (%) |
p
heterogeneity
| |||||
Univariate analysis (BCR) | ||||||
Overall | 25 | 70.9 | < 0.001 | Random | 1.56 (1.46,1.66) | < 0.001 |
Geographical region | ||||||
Asia | 12 | 72.1 | < 0.001 | Random | 1.61 (1.43,182) | < 0.001 |
Europe and North America | 12 | 70.8 | < 0.001 | Random | 1.50 (1.37,1.65) | < 0.001 |
Date of publication | ||||||
≥ 2014 | 13 | 81.8 | < 0.001 | Random | 1.52 (1.36,1.70) | < 0.001 |
< 2014 | 12 | 18.5 | 0.262 | Fixed | 1.61 (1.52,1.71) | < 0.001 |
Mean age (years) | ||||||
≥ 64 | 9 | 84 | < 0.001 | Random | 1.62 (1.34,1.97) | < 0.001 |
< 64 | 15 | 55.6 | 0.005 | Random | 1.54 (1.45,1.64) | < 0.001 |
Sample size (cases) | ||||||
≥ 500 | 10 | 40.1 | 0.09 | Random | 1.61 (1.52,1.70) | < 0.001 |
< 500 | 15 | 76.9 | < 0.001 | Random | 1.51 (1.33,1.71) | < 0.001 |
Mean p-PSA (ng/ml) | ||||||
≥ 10 | 7 | 81 | < 0.001 | Random | 1.65 (1.38,1.97) | < 0.001 |
< 10 | 14 | 58.5 | 0.003 | Random | 1.59 (1.48,1.71) | < 0.001 |
Median follow-up | ||||||
≥ 36 months | 11 | 77.1 | < 0.001 | Random | 1.49 (1.33,1.67) | < 0.001 |
< 36 months | 14 | 59.8 | 0.002 | Random | 1.61 (1.49,1.74) | < 0.001 |
BCR (ng/ml) | ||||||
Cutoff value 0.1 | 4 | 0 | 0.775 | Fixed | 1.61 (1.49,1.72) | < 0.001 |
Cutoff value 0.2 | 20 | 72 | < 0.001 | Random | 1.58 (1.46,1.70) | < 0.001 |
Cutoff value 0.4 | 1 | – | – | – | – | – |
Multivariate analysis (BCR) | ||||||
Overall | 32 | 79.2 | < 0.001 | Random | 1.35 (1.27,1.43) | < 0.001 |
Geographical region | ||||||
Asia | 14 | 67 | < 0.001 | Random | 1.42 (1.29,1.55) | < 0.001 |
Europe and North America | 15 | 84.7 | < 0.001 | Random | 1.31 (1.19,1.43) | < 0.001 |
Multi-centred | 3 | 71.9 | 0.029 | Random | 1.33 (1.00,1.78) | 0.053 |
Date of publication | ||||||
≥ 2014 | 16 | 82.9 | < 0.001 | Random | 1.27 (1.17,1.39) | < 0.001 |
< 2014 | 16 | 67.2 | < 0.001 | Random | 1.44 (1.32,1.56) | < 0.001 |
Mean age (years) | ||||||
≥ 64 | 8 | 62.5 | 0.009 | Random | 1.56 (1.32,1.85) | < 0.001 |
< 64 | 22 | 81.5 | < 0.001 | Random | 1.33 (1.24,1.43) | < 0.001 |
Sample size (cases) | ||||||
≥ 500 | 18 | 77.1 | < 0.001 | Random | 1.40 (1.32,1.49) | < 0.001 |
< 500 | 14 | 76.8 | < 0.001 | Random | 1.28 (1.12,1.47) | < 0.001 |
Mean p-PSA (ng/ml) | ||||||
≥ 10 | 7 | 80.8 | < 0.001 | Random | 1.36 (1.22,1.57) | < 0.001 |
< 10 | 19 | 79 | < 0.001 | Random | 1.35 (1.24,1.48) | < 0.001 |
Median follow-up | ||||||
≥ 36 months | 16 | 79.6 | < 0.001 | Random | 1.36 (1.24,1.46) | < 0.001 |
< 36 months | 15 | 79.8 | < 0.001 | Random | 1.34 (1.21,1.47) | < 0.001 |
BCR (ng/ml) | ||||||
Cutoff value 0.1 | 5 | 87.7 | < 0.001 | Random | 1.22 (1.01,1.48) | 0.044 |
Cutoff value 0.2 | 23 | 71.3 | < 0.001 | Random | 1.39 (1.30,1.48) | < 0.001 |
Cutoff value 0.4 | 4 | 82.2 | 0.001 | Random | 1.34 (1.15,1.57) | < 0.001 |