Nutraceutical supplements in management of pain and disability in osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

AbstractThis study designed to evaluate the effect of nutraceutical supplementation on pain intensity and physical function in patients with knee/hip OA. The MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, Google Scholar, Science direct, and ProQuest in addition to SID, Magiran, and Iranmedex were searched up to March 2020. Records (n = 465) were screened via the PICOS criteria: participants were patients with hip or knee OA; intervention was different nutritional supplements; comparator was any comparator; the outcome was pain intensity (Visual analogue scale [VAS]) and physical function (Western Ontario and McMaster Universities Arthritis [WOMAC] index); study type was randomized controlled trials. The random effects model was used to pool the calculated effect sizes. The standardized mean difference (SMD) of the outcome changes was considered as the effect size. The random effects model was used to combine the effect sizes. Heterogeneity between studies was assessed by Cochran's (Q) and I2 statistics. A total of 42 RCTs were involved in the meta-analysis. Nutritional supplementation were found to improve total WOMAC index (SMD = − 0.23, 95% CI − 0.37 to − 0.08), WOMAC pain (SMD = − 0.36, 95% CI − 0.62 to − 0.10) and WOMAC stiffness (SMD = − 0.47, 95% CI − 0.71 to − 0.23) subscales and VAS (SMD = − 0.79, 95% CI − 1.05 to − 0.05). Results of subgroup analysis according to the supplementation duration showed that the pooled effect size in studies with < 10 months, 10–20 months and > 20 months supplementation duration were 0.05, 0.27, and 0.36, respectively for WOMAC total score, 0.14, 0.55 and 0.05, respectively for WOAMC pain subscale, 0.59, 0.47 and 0.41, respectively for WOMAC stiffness subscale, 0.05, 0.57 and 0.53, respectively for WOMAC physical function subscale and 0.65, 0.99 and 0.12, respectively for VAS pain. The result suggested that nutraceutical supplementation of patients with knee/hip OA may lead to an improvement in pain intensity and physical function.

Download Full-text

P-uniform*

10.31222/osf.io/zqjr9 ◽

2018 ◽

Cited By ~ 6

Author(s):

Robbie Cornelis Maria van Aert ◽

Marcel A. L. M. van Assen

Keyword(s):

Publication Bias ◽

Random Effects ◽

Effect Size ◽

Meta Analysis ◽

Statistical Properties ◽

Selection Model ◽

Effect Sizes ◽

Random Effects Model ◽

Average Effect ◽

Model Approach

Publication bias is a major threat to the validity of a meta-analysis resulting in overestimated effect sizes. P-uniform is a meta-analysis method that corrects estimates for publication bias but overestimates average effect size if heterogeneity in true effect sizes (i.e., between-study variance) is present. We propose an extension and improvement of p-uniform called p-uniform*. P-uniform* improves upon p-uniform in three important ways, as it (i) entails a more efficient estimator, (ii) eliminates the overestimation of effect size in case of between-study variance in true effect sizes, and (iii) enables estimating and testing for the presence of the between-study variance. We compared the statistical properties of p-uniform* with p-uniform, the selection model approach of Hedges (1992), and the random-effects model. Statistical properties of p-uniform* and the selection model approach were comparable and generally outperformed p-uniform and the random-effects model if publication bias was present. We demonstrate that p-uniform* and the selection model approach estimate average effect size and between-study variance rather well with ten or more studies in the meta-analysis when publication bias is not extreme. P-uniform* generally provides more accurate estimates of the between-study variance in meta-analyses containing many studies (e.g., 60 or more) and if publication bias is present. However, both methods do not perform well if the meta-analysis only includes statistically significant studies. P-uniform performed best in this case but only when between-study variance was zero or small. We offer recommendations for applied researchers, and provide an R package and an easy-to-use web application for applying p-uniform*.

Download Full-text

Reduced Risk of Parkinson’s Disease in Users of Calcium Channel Blockers: A Meta-Analysis

International Journal of Chronic Diseases ◽

10.1155/2015/697404 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Kapil Gudala ◽

Raju Kanukula ◽

Dipika Bansal

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Calcium Channel ◽

Random Effects ◽

Calcium Channel Blockers ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Channel Blockers ◽

Random Effects Model

Aim. To pool the data currently available to determine the association between calcium channel blockers (CCBs) and risk of Parkinson’s disease (PD).Methods. Literature search in PubMed, EBSCO, and Cochrane library was undertaken through March 2014, looking for observational studies evaluating the association between CCBs use and PD. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model. Subgroup analyses, sensitivity Analysis, and cumulative meta-analysis were also performed.Results. Six studies were included in our meta-analysis according to the selection criteria, including three cohort studies and three case-control studies involving 27,67,990 subjects including 11,941 PD cases. We found CCBs use was associated with significant decreased risk of PD, compared with not using CCBs (random effects model pooled RR, 0.81 (95% CI, 0.69–0.95)); a significant heterogeneity was found between studies (P=0.031;I254.6%). Both the classes of CCB, that is, dihydropyridine calcium channel blockers (DiCCB) (0.80 (95% CI, 0.65–0.98)P=0.032) and non-DiCCB (0.70 (95% CI, 0.53–0.92)P=0.013), were found to be reducing the risk of PD.Conclusion. In our analysis, we found that CCBs use was associated with a Significantly decreased risk of PD compared with non-CCB use.

Download Full-text

The effect of cooperative learning on academic achievement: A meta-analysis on the relationship between the study group size and effect size İşbirlikli öğrenmenin başarıya etkisi: Çalışma grubu ile etki büyüklüğü arasındaki ilişkiye dair bir meta analiz çalışması

Journal of Human Sciences ◽

10.14687/jhs.v14i1.4314 ◽

2017 ◽

Vol 14 (1) ◽

pp. 473 ◽

Cited By ~ 1

Author(s):

Murat Tuncer ◽

Melih Dikmen

Keyword(s):

Cooperative Learning ◽

Random Effects ◽

Effect Size ◽

Fixed Effects ◽

Meta Analysis ◽

Experimental Studies ◽

Study Group ◽

Random Effects Model ◽

Learning Groups ◽

The Relationship

The purpose of this study was to determine the effect of cooperative learning on achievement and the relationship between the study group and effect size by means of meta-analysis. Meta-analysis is the method employed in order to statistically analyze the quantitative data collected in independent and multiple studies carried out on similar topics, and to reach a general judgment regarding the results of these studies. Certain criteria were used in order to decide which researches would be included in the meta-analysis. Based on these criteria, it was decided to include 6 experimental studies in the meta-analysis. As a result, for the six studies, the effect size calculated within 95 % confidence interval has proved to be .518 based on random effects model. When two studies with the largest learning groups are excluded from the research respectively, firstly this effect size increases to .528, later it is calculated as .817 without any model discrimination. When effect size intervals in literature (≥ 0.5: strong, ≥ 0.3: moderate and ≥ .01 weak) is taken into consideration, the effect of cooperative learning on achievement has been observed as “Strong”. In addition to this, contrary to some views in literature, it has been seen that large learning groups have higher standard errors and a bigger effect size has been achieved when such studies have been excluded from the analysis. What is more, even the limitation of fixed effects model has disappeared, and the effect size calculated in fixed effects and random effects model has been balanced. ÖzetBu araştırmanın amacı, işbirlikli öğrenmenin başarı üzerindeki etkisini ve çalışma grubu ile etki büyüklüğü arasındaki ilişkiyi meta-analiz yöntemiyle belirlemektir. Meta-analiz, benzer konularda yapılmış birbirinden bağımsız ve çok sayıda çalışmadan elde edilmiş sayısal verileri istatistiksel olarak analiz etme ve bu çalışmaların sonuçları hakkında genel bir yargıya varma yöntemidir. Hangi araştırmaların meta-analize dâhil edileceğine yönelik seçimlerin yapılmasında belirli ölçütler kullanılmıştır. Bu ölçütlere dayalı olarak 6 adet deneysel araştırmanın meta-analize dâhil edilmesine karar verilmiştir. Sonuç olarak; altı çalışma için %95 güven aralığında hesaplanan etki büyüklüğü rastgele etkiler modeline göre .518’dir. En büyük çalışma grubuna sahip iki araştırma sırasıyla araştırma dışında tutulduğunda bu etki büyüklüğü önce .528’ e çıkmakta, sonrasında ise model ayrımı olmaksızın .817 olarak hesaplanmaktadır. Alan yazındaki etki büyüklüğü aralıkları (≥ 0.5: güçlü, ≥ 0.3: orta düzey ve ≥ .01 zayıf) dikkate alındığında işbirlikli öğrenmenin başarı üzerindeki etkisi “Güçlü” bir etki olarak gözlenmiştir. Ayrıca alan yazındaki bazı görüşlerin aksine büyük çalışma gruplarının standart hatalarının daha yüksek olduğu, bu araştırmaların analiz dışında tutulması ile daha büyük etki büyüklüklerine ulaşıldığı, hatta sabit etki modelinin sınırlılığının bile ortadan kalktığı, sabit etki ve rastgele etki modelinde hesaplanan etki büyüklüğünün eşitlendiği görülmüştür.

Download Full-text

A meta-analysis on parochial cooperation among children and adolescents

10.31234/osf.io/uexmr ◽

2020 ◽

Author(s):

Aleksandra Lazić ◽

Danka Purić ◽

Ksenija Krstic

Keyword(s):

Decision Making ◽

Children And Adolescents ◽

Experimental Economics ◽

Random Effects ◽

Effect Size ◽

Meta Analysis ◽

Random Effects Model ◽

Personal Cost ◽

Cooperative Decision Making ◽

Economics Research

This meta-analysis integrated findings from a recent upsurge of economic experiments (2008–2019) exploring parochialism in cooperative decision-making of children and adolescents. Based on 20 studies (k = 69, N = 5268, age = 3–19 years), a random-effects model revealed a small overall effect size indicating that children and adolescents were more willing to incur a personal cost to benefit ingroups, compared to outgroups (d = 0.17). A series of single-moderator analyses tested boundary conditions of this tendency. The implications for the methodologies currently used in experimental economics research are discussed.

Download Full-text

Diabetes in Pakistan: A systematic review and meta-analysis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.194 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 3

Author(s):

Sohail Akhtar ◽

Jamal Abdul Nasir ◽

Tahir Abbas ◽

Aqsa Sarwar

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Family History ◽

Random Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Model ◽

Continuous Increase ◽

Family History Of Diabetes ◽

Factors Associated

Objective: The purpose of this study was assess the time trend of the prevalence of prediabetes and diabetes and risk factors associated with diabetes in Pakistan by using a systematic review and meta–analysis. Methods: A systematic literature search of Embase, PubMed, and the Cochrane library was carried out between January 1, 1995 and August 30, 2018. Diabetes and prediabetes prevalence estimates were combined by the random–effects model. The existence of publication bias was tested by Egger regression. This systematic review was reported following the PRISMA guidelines. Results: The search conceded a total of 635 studies, only 14 studies were considered for meta-analysis. The prevalence of diabetes in Pakistan was revealed 14.62% (10.651%–19.094%; 14 studies) based on 49,418 people using the inverse–variance random–effects model. The prevalence of prediabetes was 11.43% (8.26%–15.03%; 10 studies) based on a total sample of 26,999 people. The risk factors associated with diabetes were mean age (β = 0.48%, 95% CI: 0.21–0.78, p<0.001), the proportion of participants with a family history of diabetes (β = 0. 45%, 95% CI: 0.08–0.82, p =0.018, p<0.001), hypertension (β = 0.40%, 95% CI: 0.06–0.75, p = 0.022), weight (BMI) (β = 0.21%, 95% CI: 0.02–0.4, p=0.030). Conclusions: There has been a continuous increase in the prevalence of prediabetes and diabetes in Pakistan. All parts of the country have been affected, with the highest in Sindh and lowest in Khyber Pakhtunkhwa. The main factors include growing age, family history, hypertension and obesity. A nationwide diabetes care survey on risk factors and prevention policy is highly recommended. doi: https://doi.org/10.12669/pjms.35.4.194 How to cite this:Akhtar S, Nasir JA, Abbas T, Sarwar A. Diabetes in Pakistan: A systematic review and meta-analysis. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.194 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Ear mould for congenital auricular deformities: a protocol for systematic review and meta-analysis

10.21203/rs.3.rs-40986/v1 ◽

2020 ◽

Author(s):

Jincheng Huang ◽

Kun Zou ◽

Ping Yuan ◽

Longhao Zhang ◽

Min Yang ◽

...

Keyword(s):

Systematic Review ◽

Random Effects ◽

Fixed Effects ◽

Meta Analysis ◽

Evidence Base ◽

Small Sample ◽

Cochrane Library ◽

Random Effects Model ◽

High Quality ◽

Effectiveness Rate

Abstract Background: Congenital auricle deformities (CADs) not only affect the appearance, but may also result in social inferiority or difficulties, influence the hearing and mental health of the children. Although some studies have pointed out CADs have a natural improvement trend, there is still a lack of high-quality research to demonstrate the degree of that. Therefore, related studies agree that early treatment are necessary. Ear mold correction is currently main non-surgical treatment for CADs, but the existing research often involves a small sample size, and the research conclusions are inconsistent. More importantly, there is still no systematic review on ear mold correction for CADs. This study aims to systematically evaluate the effectiveness and safety of ear mold correction for CADs, so as to provide an evidence base for further research.Methods: The study has been designed according to the Preferred Reporting program for Systems Evaluation and Meta-analysis Protocol (PRISMA-P). We will search electronic literature databases of PubMed, Embase, Cochrane Library, Web of science, CBM, CNKI, Wanfang and VIP from their initiative to 1 June 2020 for interventional studies on ear mould for children with CADs. The study selection, data extraction and quality assessment will be performed by two authors. Meta-analysis will be conducted on primary outcome effectiveness rate of physician assessment and secondary outcomes of effectiveness rate of parents’ assessment, effectiveness score, hearing assessment, and adverse reactions using relative ratio or mean difference and their 95% confidence intervals. The heterogeneity of the included studies will be tested using Chi square test and I2, and random-effects model will be used when significant heterogeneity was found, otherwise, fixed-effects model will be used. Sensitivity analysis will be performed using trials with high quality and using alternative [1]models (fixed-effects or random effects model). Publication bias will be tested using funnel plot and Egger’s test. Discussion: This study will be the first to systematically evaluate the effectiveness and safety of ear mold correction for CADs, to provide evidence base for clinical guideline making, clinical decision and future research. Systematic review registration : CRD42020190982.

Download Full-text

Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis

Public Health Reviews ◽

10.3389/phrs.2021.1603969 ◽

2021 ◽

Vol 42 ◽

Author(s):

Tadesse Tolossa ◽

Getahun Fetensa ◽

Bikila Regassa ◽

Mekdes Tigistu Yilma ◽

Merga Besho ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Random Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Diabetic Patients ◽

Special Focus ◽

Significant Heterogeneity ◽

Random Effects Model ◽

Patients With Diabetes

Background: Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes.Methods: Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger’s statistical tests.Results: Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I2 = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07–21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14–0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34–0.77) were found to have significant association with CKD.Conclusion: The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.

Download Full-text

Effectiveness of Acupuncture in Relieving Chemotherapy-induced Leukopenia in Patients With Breast Cancer: A Systematic Review With A Meta-Analysis and Trial Sequential Analysis

Integrative Cancer Therapies ◽

10.1177/15347354211063884 ◽

2021 ◽

Vol 20 ◽

pp. 153473542110638

Author(s):

Ya Wen Shih ◽

Jui Yuan Su ◽

Yu Shan Kung ◽

Yu Huei Lin ◽

Duong Thi To Anh ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Random Effects ◽

Sequential Analysis ◽

Meta Analysis ◽

White Blood Cells ◽

Cochrane Library ◽

Common Side Effect ◽

Trial Sequential Analysis ◽

Random Effects Model

Background: Breast cancer is one of the most common cancers and a major cause of death in women worldwide. Chemotherapy is mainly used to treat and control the progression of breast cancer. Leukopenia is the most common side effect of chemotherapy which may decrease immune function and further lead to serious fatal infections. The purpose of this study was to evaluate the effect of acupuncture on regulating hematopoietic function in chemotherapy-induced leukopenia among patients with breast cancer. Methods: PubMed, Embase, Cochrane Library, CINAHL Plus, Web of Science, and Chinese articles in the Airiti Library and China National Knowledge Infrastructure (CNKI) databases were searched to August 2021 for papers to include in a systematic review and meta-analysis. A random-effects model was applied. The effect size was calculated by Hedges’ g. Heterogeneity was determined using Cochran’s Q test. Moderator analyses were performed to examine potential sources of heterogeneity. A trial sequential analysis (TSA) was conducted to determine whether the current sample size was sufficient. Results: Ten randomized controlled trials involving 650 participants were eligible for inclusion. Analysis by the random-effects model showed a significant effect by acupuncture of ameliorating leukopenia during chemotherapy. Levels of white blood cells (WBCs) were increased (Hedges’ g = 0.70, P < .001, I2 = 34%), neutrophil counts (Hedges’ g = 0.80, P < .001, I2 = 0%) were significantly enhanced. Moreover, regardless of the manner through which acupuncture was applied, overall values of WBCs increased. Conclusions: The current meta-analysis supports acupuncture possibly ameliorating chemotherapy-induced leukopenia, as WBC and neutrophil values significantly increased after acupuncture in patients undergoing chemotherapy. Additionally, regardless of the type of acupuncture, values of WBCs increased. These findings are actionable and support both the clinical use of acupuncture to relieve chemotherapy-induced leukopenia and further research regarding the use of acupuncture in patients experiencing immunosuppression when undergoing chemotherapy. Trial Registration: PROSPERO-CRD42020215759.

Download Full-text

The Association between Season and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-1020061/v1 ◽

2021 ◽

Author(s):

Lingyun Liao ◽

Xiaohong Wei ◽

Min Liu ◽

Yijie Gao ◽

Yangxue Yin ◽

...

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Random Effects ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Model ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

The Cochrane Library

Abstract Background: There is increasing and inconsistent evidence of a relationship between hypertensive disorders of pregnancy (HDP) and season of delivery or conception.Methods: Four databases, the Cochrane Library, PubMed, EMBASE and Web of Science, were searched until September 29th, 2021. Two authors extracted data independently. A random effects model and the Mantel-Haenszel method were used to calculate pooled ORs and 95% CIs.Results: Twenty articles were included in the systematic review, and 11 articles were included in the meta-analysis. The quantitative analysis of the association between delivery season and HDP showed that the odds of HDP was higher in women who deliver in winter than in those who delivered in summer (OR=1.18, 95% CI 1.02-1.38, p < 0.001) and all other seasons (OR = 1.17, 95% CI 1.03-1.34, p <0.001). In the qualitative analysis of the association between conception season and HDP, 4 of 7 studies suggested that women who conceived in summer had a higher risk of HDP than those who conceived in other seasons.Conclusions: Based on the evidence to date, we found weakly positive relationships between HDP and summer conception and winter delivery.

Download Full-text

Comparison of efficacy of robotic surgery, laparoscopy, and laparotomy in the treatment of ovarian cancer: a meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1702-9 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Can Shi ◽

Yingchun Gao ◽

Yijun Yang ◽

Lei Zhang ◽

Juanpeng Yu ◽

...

Keyword(s):

Ovarian Cancer ◽

Robotic Surgery ◽

Publication Bias ◽

Random Effects ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Model ◽

Fixed Effects Model ◽

Estimated Blood Loss

Abstract Background We intended to compare the clinical effect of robotic surgery with laparoscopy and laparotomy in ovarian cancer treatment. Methods The included studies were retrieved from PubMed, Embase, and the Cochrane Library databases. The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the study quality. Effect measures were presented with weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval (CI), and heterogeneity test was assessed using Q test and I2 statistics to determine the use of the random effects model or fixed effects model. Egger’s test was used to assess the publication bias. Results A total of eight studies was included in this meta-analysis with a MINORS score of 16–18. In the random effects model, estimated blood loss (EBL) of robotic surgery was significantly less compared with laparotomy (WMD = − 521.7027, 95% CI − 809.7816; − 233.6238). In the fixed effects model, length of hospital stay (LHS) (WMD = − 5.2225, 95% CI − 6.1485; − 4.2965) and postoperative complication (PC) (OR = 0.4710, 95% CI 0.2537; 0.8747) of robotic surgery were significantly less, and overall survival (OS) rate (OR = 6.4355, 95% CI 1.6722; 24.7678, P = 0.0070) of robotic surgery was significantly higher compared with laparotomy. There was no difference in the effect size of all variables between robotic surgery and laparoscopy. Meanwhile, a publication bias (t = 6.8290, P = 0.002405) was only identified for PC in robotic surgery and laparotomy groups; no publication bias was identified for the other variables. Conclusions Despite the above results, it failed to show oncological safety and recurrence by pathological stages or histologic types in this meta-analysis, and those confounding factors might affect the clinical outcome. Future meta-analyses with a larger number of eligible randomized controlled trial studies were needed to determine the most suitable treatment method for patients with different stages and types of ovarian cancer.

Download Full-text