Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

// Xuwei Hong 1,* , Tieqiu Li 2,* , Fengsheng Ling 1,* , Dashan Yang 1 , Lina Hou 3,* , Fei Li 1,* and Wanlong Tan 1,* 1 Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China 2 Department of Urology, The People’s Hospital of Hunan Province, First Affiliated Hospital of Hunan Normal University, Changsha, P. R. China 3 Department of Healthy Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China. * These authors have contributed equally to this work Correspondence to: Wanlong Tan, email: // Fei Li, email: // Lina Hou, email: // Keywords : bladder cancer, surgical margin status, radical cystectomy, outcome, meta-analysis Received : April 29, 2016 Accepted : October 14, 2016 Published : October 25, 2016 Abstract Data regarding the association between surgical margin status and the outcome of bladder cancer treated by radical cystectomy (RC) are conflicting. Therefore, the present meta-analysis was performed to assess the associations between the outcomes of bladder cancer, in terms of recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS), and the presence of positive surgical margins versus negative surgical margins following treatment with RC. Research articles published prior to April 2016 were identified from Pubmed, Embase and the Cochrane Library databases. A total of 36 articles were included, with a sample size of 38,384 bladder cancer patients. Of these, 4,354 patients were reported to have positive surgical margins. Significant associations were detected between positive surgical margins following RC and unfavorable RFS [summary relative risk estimate (SRRE), 1.63; 95% confidence interval (CI), 1.46-1.83; P = 0.105], CSS (SRRE, 1.82; 95% CI, 1.63-2.04; P = 0.001) and OS (SRRE, 1.68; 95% CI, 1.58-1.80; P = 0.805), by fixed or random effects models. The findings were consistent independently of age, sample size, publication year, follow-up duration, study type and geographical region. In summary, the present findings demonstrate that the presence of positive surgical margins is associated with poor survival outcomes in bladder cancer following RC, indicating that avoidance of positive surgical margins during surgery is helpful to improve the prognosis of patients with bladder cancer.