Introduction
Materials and methods
Literature search
Inclusion and exclusion criteria
Data extraction and quality assessment
Statistical analysis
Results
Search results
Study characteristics and quality assessments
Author | Year | Country | No. of patients | Recruitment period | Age (years) | p-PSA (ng/ml) | Specimen GS ≦ 7/> 7 | Pathological stage1–2/3–4 | SM+/SM− | Follow-up (months) | Survival analysis |
---|---|---|---|---|---|---|---|---|---|---|---|
Kliment et al. [12] | 2017 | Slovak Republic | 114 | 1995–2012 | Mean ± SD 62.6 ± 5.9 | Median (range) 10.5 (3.2–100) | 58/56 | 0/114 | 64/50 | Median (range) 62 (4–205) | BRFS |
Fujimura et al. [13] | 2017 | Japan | 908 | 2005–2016 | Median (range) 67 (47–80) | Median 7.9 | 777/130 | 650/258 | 302/606 | NA | BRFS |
Heering et al. [14] | 2017 | Denmark | 6857 | 1995–2011 | Median (IQR) 64.1 (60.3–67.6) | Median (IQR) 8.9 (6.2–13.0) | 6127/592 | 4812/2565 | 1481/4805 | Median 76.8 | CSM |
Zhang et al. [15] | 2016 | China | 205 | 2009–2013 | Median (IQR) 68 (62–73) | Median (IQR) 13.1 (7.9–17.7) | 171/34 | 118/87 | 51/154 | Median (range) 43.8 (2–60) | BRFS |
Xu et al. [16] | 2016 | China | 243 | 2005–2010 | Mean ± SD 68 ± 7.04 | Mean ± SD 13.99 ± 10.21 | 204/39 | 219/24 | 37/206 | Median (range) 61 (7–97) | BRFS |
Moschini et al. [17] | 2016 | USA | 1011 | 1987–2012 | NA | Median 12.0 | 647/364 | 355/657 | 566/445 | Median 211.2 | CSM, OM |
Raheem et al. [18] | 2016 | Korea | 800 | 2005–2010 | Mean ± SD 64.3 ± 7.4 | Median (IQR) 7.2 (5–12) | 628/172 | 487/313 | 293/507 | Median (IQR) 57 (23.2–65.8) | CSS |
Moris et al. [19] | 2016 | USA | 1249 | 1989–2011 | Median (IQR) 66 (60–70) | Median (IQR) 18.2 (8.1–33) | 807/442 | 300/949 | 671/578 | Median (IQR) 24.3 (11–56) | CSS, OS |
Boehm et al. [20] | 2016 | European | 8741 | 1992–2009 | NA | Median (IQR) 6.5 (4.7–9.7) | 8465/276 | 6187/2553 | 1541/7200 | Median (IQR) 65.6 (48.3–96.7) | CSM |
Mithal et al. [8] | 2016 | Multi-centres | 4051 | 1988–2013 | Mean 62 | NA | 3561/490 | 3069/982 | 1600/2451 | Median (IQR) 79.2 (38.4–127.2) | CSM, OS |
Maxeiner et al. [21] | 2016 | Germany | 441 | 1999–2007 | Median (IQR) 63 (59–66) | Median (IQR) 8.3 (5.3–13) | 293/148 | 422/19 | 113/328 | Median (IQR) 81.9 (59.7–108.7) | BRFS |
Eminaga et al. [22] | 2016 | Multi-centres | 1180 | NA | Median (range) 61 (35–80) | Mean ± SD 8.63 ± 8.36 | 1065/107 | NA | 347/666 | Median 60 | BRFS, CSS, OS |
Liu et al. [23] | 2015 | Japan | 160 | 2007–2010 | NA | NA | 125/35 | 94/66 | 15/155 | Median (range) 51 (6–76) | BRFS |
Kim et al. [24] | 2015 | Korea | 613 | 2005–2013 | Median (range) 66 (44–89) | Median (range) 8 (1–79) | 202/79 | 544/79 | 151/462 | Median (range) 44 (12–154) | BRFS |
Jeong et al. [25] | 2015 | USA | 15,565 | 1982–2012 | Mean ± SD 58.3 ± 7.8 | Mean ± SD 6.8 ± 5.8 | 13,277/2288 | NA | 2132/13,433 | Median (range) 108 (12–324) | BRFS, CSS, OS |
Rouanne et al. [26] | 2014 | France | 403 | 1988–2001 | Median (range) 66 (46–81) | Median (range) 10 (0.5–158) | 340/63 | 403/0 | 108/295 | Median (range) 147 (126–251) | BRFS |
Park et al. [27] | 2014 | Korea | 1007 | 2007–2012 | NA | NA | 838/169 | 634/373 | 228/779 | Median (IQR) 32 (15.6–45.9) | BRFS |
Knoedler et al. [28] | 2014 | USA | 18,916 | 1987–2009 | Median (IQR) 63 (58–68) | Median (IQR) 6.3 (4.4–9.8) | 12,469/993 | 10,258/3425 | 4007/14,909 | Median (IQR) 112.8 (60–174) | CSM, OM |
Touijer et al. [29] | 2014 | USA | 369 | 1988–2010 | Median (IQR) 62 (57–66) | Median (IQR) 8 (5–15) | 184/185 | 46/323 | 138/231 | Median 48 | CSM |
Fairey et al. [30] | 2014 | USA | 229 | 1987–2008 | Median (range) 65 (41–83) | NA | 133/96 | 0/229 | 105/124 | Median (range) 174 (2.4–253.2) | OM |
Sukumar et al. [31] | 2014 | USA | 5152 | 2001–2010 | Mean ± SD 60 ± 7.3 | Mean ± SD 6.1 ± 4.6 | 4341/462 | 3150/1653 | 1162/3990 | Median (IQR) 26.4 (12.2–54.6) | CSS |
McNeill et al. [32] | 2014 | Germany | 575 | 2006–2012 | Mean (range) 62 (40.3–76.5) | Mean 7.5 | 533/42 | 406/169 | 135/440 | Median (IQR) 30 (19.3–44.0) | BRFS |
Zhong et al. [33] | 2012 | USA | 240 | 1993–1995 | Mean 61 | NA | 206/34 | 181/59 | 92/148 | NA | BRFS, OS |
Mitchell et al. [34] | 2012 | USA | 843 | 1987–1997 | Median (IQR) 65 (60–69) | Median (IQR) 10.2 (4.7–23.7) | 715/128 | 223/629 | 472/371 | Median (range) 171.6 (0–564) | CSM, OM |
Min et al. [35] | 2012 | Korea | 830 | 1993–2009 | Mean (range) 65.2 (41–85) | Mean (range) 12.3 (1.2–45.7) | 719/109 | 508/322 | 307/523 | Mean (range) 47.6 (13–87) | BRFS |
Lewinshtein et al. [36] | 2012 | USA | 91 | 1988–1997 | mEdian (IQR) 65 (61–69) | median (IQR) 9.7 (6.1–13.4) | 0/91 | 28/62 | 48/43 | Median (IQR) 98.4 (54–150) | CSM |
Joniau et al. [37] | 2012 | Germany | 51 | 1989–2004 | Mean ± SD 64.2 ± 6.4 | Median (range) 16.9 (2.8–123) | NA | 19/32 | 32/19 | Median (range) 108 (11–210) | BRFS |
Dorin et al. [38] | 2012 | USA | 2487 | 1988–2008 | NA | NA | 2169/312 | 1783/702 | 658/1982 | Median (range) 86.4 (12–252) | BRFS, OS |
Oh et al. [39] | 2011 | Korea | 534 | 2003–2008 | Mean ± SD 64.9 ± 6.7 | mean ± SD 11.9 ± 12.2 | 475/59 | NA | 200/334 | Mean ± SD 51.2 ± 13.5 | BRFS |
Ku et al. [40] | 2011 | Korea | 407 | 1996–2005 | Mean (range) 66.5 (41.8–85.7) | Mean (range) 8.6 (0.7–142) | 339/68 | NA | 149/258 | Median (range) 18.1 (1–107.8) | BRFS |
Villari et al. [41] | 2010 | Italy | 1317 | 1994–2005 | Median (range) 67 (38–82) | median (range) 10 (2.05–73) | NA | 874/443 | 311/1006 | Mean (range) 80.2 (4–168) | BRFS, CSS, OS |
Wright et al. [42] | 2010 | Multi-centres | 65,633 | 1998–2006 | NA | NA | NA | 56,892/8741 | 13,905/51,728 | Median (range) 50 (1–107) | CSM |
Meta-analysis
Analysis specification | No. of studies | Study heterogeneity | Effects model | Pooled HR (95% CI) | P value | |
---|---|---|---|---|---|---|
I2 (%) |
P
heterogeneit
| |||||
BRFS | ||||||
Overall | 19 | 57.7 | 0.001 | Random | 1.35 (1.28, 1.43) | < 0.001 |
Geographical region | ||||||
Asia | 9 | 65.6 | 0.003 | Random | 1.44 (1.30, 1.61) | < 0.001 |
Other regions | 10 | 0 | 0.634 | Fixed | 1.27 (1.22, 1.31) | < 0.001 |
Date of publication | ||||||
≥ 2015 | 9 | 68.3 | 0.001 | Random | 1.42 (1.29, 1.55) | < 0.001 |
< 2015 | 10 | 48 | 0.044 | Random | 1.30 (1.20, 1.41) | < 0.001 |
Mean age (years) | ||||||
≥ 65 | 9 | 75.7 | < 0.001 | Random | 1.43 (1.28, 1.60) | < 0.001 |
< 65 | 7 | 19.4 | 0.282 | Fixed | 1.26 (1.16, 1.37) | < 0.001 |
Sample size (cases) | ||||||
≥ 800 | 7 | 65.9 | 0.007 | Random | 1.33 (1.23, 1.43) | < 0.001 |
< 800 | 12 | 53 | 0.016 | Random | 1.38 (1.26, 1.52) | < 0.001 |
Mean p-PSA (ng/ml) | ||||||
≥ 10 | 8 | 65.6 | 0.005 | Random | 1.32 (1.13, 1.53) | < 0.001 |
< 10 | 7 | 68.1 | 0.005 | Random | 1.38 (1.27, 1.50) | < 0.001 |
Median follow-up | ||||||
≥ 65 months | 6 | 0 | 0.421 | Fixed | 1.27 (1.22, 1.32) | < 0.001 |
< 65 months | 11 | 59.5 | 0.006 | Random | 1.39 (1.27, 1.53) | < 0.001 |
Adjuvant radiotherapy | ||||||
Yes | 2 | 0 | 0.628 | Fixed | 1.37 (1.11, 1.68) | 0.003 |
No | 16 | 64 | < 0.001 | Random | 1.35 (1.27, 1.44) | < 0.001 |
CSS | ||||||
Overall | 6 | 72.5 | 0.003 | Random | 1.49 (1.16, 1.90) | 0.001 |
Geographical region | ||||||
Other regions | 5 | 76.8 | 0.002 | Random | 1.47 (1.12, 1.92) | 0.005 |
Date of publication | ||||||
≥ 2015 | 4 | 71.5 | 0.015 | Random | 1.45 (1.14, 1.84) | 0.003 |
< 2015 | 2 | 84.6 | 0.011 | Random | 1.58 (0.74, 4.34) | 0.377 |
Mean age (years) | ||||||
≥ 65 | 2 | 73.1 | 0.054 | Random | 1.35 (0.74, 2.45) | 0.328 |
< 65 | 4 | 74.9 | 0.007 | Random | 1.54 (1.13, 2.09) | 0.006 |
Mean p-PSA (ng/ml) | ||||||
≥ 10 | 2 | 73.1 | 0.054 | Random | 1.35 (0.74, 2.45) | 0.328 |
< 10 | 4 | 74.9 | 0.007 | Random | 1.54 (1.13, 2.09) | 0.006 |
Median follow-up | ||||||
≥ 65 months | 2 | 0 | 0.472 | Fixed | 1.15 (1.04, 1.28) | 0.006 |
< 65 months | 4 | 1.8 | 0.383 | Fixed | 1.71 (1.43, 2.04) | < 0.001 |
OM | ||||||
Overall | 4 | 62.9 | 0.044 | Random | 1.09 (1.02, 1.16) | 0.009 |
Date of publication | ||||||
< 2015 | 3 | 73.3 | 0.024 | Random | 1.07 (0.99, 1.18) | 0.002 |
Mean age (years) | ||||||
≥ 65 | 2 | 41.6 | 0.191 | Fixed | 1.11 (1.04, 1.79) | 0.004 |
Sample size (cases) | ||||||
≥ 800 | 3 | 49.5 | 0.138 | Fixed | 1.06 (0.99, 1.14) | 0.115 |
Mean p-PSA (ng/ml) | ||||||
≥ 10 | 2 | 26.4 | 0.244 | Fixed | 1.10 (1.01, 1.19) | 0.026 |
Adjuvant radiotherapy | ||||||
Yes | 3 | 0 | 0.396 | Fixed | 1.12 (1.08, 1.16) | < 0.001 |
OS | ||||||
Overall | 7 | 63.9 | 0.011 | Random | 1.11 (1.02, 1.20) | 0.014 |
Date of publication | ||||||
≥ 2015 | 4 | 75 | 0.007 | Random | 1.10 (0.99, 1.23) | 0.082 |
< 2015 | 3 | 0 | 0.772 | Fixed | 1.15 (1.05, 1.25) | 0.002 |
Mean age (years) | ||||||
≥ 65 | 2 | 23.8 | 0.252 | Fixed | 1.36 (1.09, 1.70) | 0.007 |
< 65 | 4 | 0 | 0.827 | Fixed | 1.03 (0.99, 1.07) | 0.212 |
Sample size (cases) | ||||||
≥ 800 | 6 | 69.9 | 0.005 | Random | 1.11 (1.02, 1.22) | 0.016 |
Mean p-PSA (ng/ml) | ||||||
< 10 | 3 | 0 | 0.572 | Fixed | 1.03 (0.97, 1.09) | 0.358 |
Median follow-up | ||||||
≥ 65 months | 4 | 50.4 | 0.109 | Fixed | 1.06 (0.99, 1.13) | 0.074 |
< 65 months | 2 | 0 | 0.444 | Fixed | 1.41 (1.18, 1.69) | < 0.001 |