scholarly journals O-L05 Do Subsets of Patients with Intrahepatic Cholangiocarcinoma and Combined Hepatocellular-Cholangiocarcinoma Benefit from Transplantation? A Systematic Review, Proportional Meta-Analysis and Meta-Regression

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
William Cambridge ◽  
Thomas Drake ◽  
Cameron Fairfield ◽  
Rachel Guest
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Meta Analysis ◽  
Microvascular Invasion ◽  
Type I ◽  
Type Ii ◽  
Combined Hepatocellular Cholangiocarcinoma ◽  
Meta Regression ◽  
The Impact

Abstract Background Resection remains the main curative treatment option for intrahepatic cholangiocarcinoma (iCCA) and combined hepatocellular-cholangiocarcinoma (cHCC-CCA), however, outcomes are poor. Recent retrospective analyses of patients found to have incidental iCCA and cHCC-CCA following transplantation have suggested that transplantation may be superior to resection. We performed a systematic review and proportional meta-analysis to estimate the benefit of transplantation for iCCA and cHCC-CCA. Methods MEDLINE, EMBASE, Scopus, and Web of Science were searched from January 1990 to December 2020. All studies reporting patients with iCCA and cHCC-CCA undergoing transplantation were identified. A proportional meta-analysis was performed, pooling overall survival (OS), disease-free survival (DFS), and recurrence rates post-transplantation. Sub-group analyses were performed for patients with ‘early’ iCCA, ‘advanced’ iCCA, Goodman type I cHCC-CCA, and Goodman type II cHCC-CCA. Univariable meta-regression was completed assessing the impact of variables reported by at least five studies on OS and DFS at 5-years, as well as recurrence post-transplant. Results Twenty-eight studies including 489 patients were identified (249 with iCCA and 240 with cHCC-CCA). Pooled OS and DFS at 5-years were lower in the iCCA group, 30.2% (95% CI 18.6% – 43.1%) and 29.2% (95% CI 20.4% – 38.9%), compared to the cHCC-CCA group, 55.0% (95% CI 47.2% – 62.8%) and 43.2% (95% CI 30.2% – 56.7%). In the ‘early’ iCCA group, pooled OS at 5-years was 66.5% (95% CI 47.2% – 83.3%). When separated by Goodman type, those with type II tumours reported higher pooled OS, 69.7% (95% CI 57.8% – 80.5%), compared to type I tumours, 61.3% (95% CI 46.1 – 75.5). Univariable meta-regression found only microvascular invasion impacted overall survival at 5-years and recurrence following transplantation in the iCCA group. At 5-years there was a negative correlation between the proportion of patients found to have microvascular invasion and overall survival (Adjusted R2 = 0.89, p = 0.017). There was a positive correlation between the proportion of patients with microvascular invasion on explant pathology and recurrence following transplantation (Adjusted R2 = 0.76, p = 0.047). Conclusions Subsets of patients with iCCA and cHCC-CCA may benefit from liver transplantation. However, further research, including clinical trials exploring transplantation in 'early' disease and in comparison to resection, is required to conclude which subsets of patients will benefit most from transplantation.

scholarly journals P20-8 The impact of valproic acid on overall survival in patients with glioblastoma: A systematic review and meta-analysis

2021 ◽  
Vol 32 ◽  
pp. S340
Author(s):  
Charlotte A. Jonatan ◽  
Elizabeth Marcella ◽  
Jeannette Tandiono ◽  
Sharon Chen ◽  
Felix Wijovi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Valproic Acid ◽  
Overall Survival ◽  
Meta Analysis ◽  
The Impact

Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

2021 ◽  
Vol 71 (4) ◽  
pp. 187-193
Author(s):  
Putu Astawa ◽  
Made Agus Maharjana ◽  
Surya Adisthanaya ◽  
Made Winatra Satya Putra ◽  
Agus Suarjaya Putra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Meta Analysis ◽  
Fixed Effect Model ◽  
Cosmetic Outcome ◽  
Type I ◽  
Type Ii ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Humerus Fractures

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.

Carbapenem Resistance, Initial Antibiotic Therapy, and Mortality inKlebsiella pneumoniaeBacteremia: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 38 (11) ◽  
pp. 1319-1328 ◽  
Author(s):  
Philipp P. Kohler ◽  
Cheryl Volling ◽  
Karen Green ◽  
Elizabeth M. Uleryk ◽  
Prakesh S. Shah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Meta Analysis ◽  
Carbapenem Resistance ◽  
Carbapenem Resistant ◽  
Initial Antibiotic Therapy ◽  
Meta Regression ◽  
The Difference ◽  
Meta Regression Analysis ◽  
The Impact

BACKGROUNDMortality associated with infections caused by carbapenem-resistantEnterobacteriaceae(CRE) is higher than mortality due to carbapenem-sensitive pathogens.OBJECTIVETo examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitiveKlebsiella pneumoniae(CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.DESIGNSystematic review and meta-analysisMETHODSWe searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related toKlebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.RESULTSMortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).CONCLUSIONSAppropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.Infect Control Hosp Epidemiol2017;38:1319–1328

The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis

2020 ◽  
Vol 27 (9) ◽  
pp. 3553-3564 ◽  
Author(s):  
Veronica McSharry ◽  
Amy Mullee ◽  
Lara McCann ◽  
Ailin C. Rogers ◽  
Mary McKiernan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Epithelial Ovarian Cancer ◽  
Meta Analysis ◽  
Muscle Attenuation ◽  
The Impact

Systematic Review and Meta-Analysis of the Association Between Transfusion Independence (TI) and Overall Survival (OS) in Patients (pts) with Myelodysplastic Syndromes (MDS)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1934-1934
Author(s):  
Sue Harnan ◽  
Shijie Ren ◽  
Tim Gomersall ◽  
Emma Everson-Hock ◽  
Anthea Sutton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Lower Risk ◽  
Research Funding ◽  
Meta Analysis ◽  
Type A ◽  
Type B ◽  
Risk Of Death ◽  
Meta Regression ◽  
The Impact

Abstract Introduction: MDS are a diverse group of haematological disorders affecting bone marrow function and necessitating frequent blood transfusions. A number of studies, from retrospective cohort and registry analyses to randomized controlled trials (RCTs), have shown transfusion status to impact OS in MDS. While transfusion status is considered a prognostic indicator in MDS, no systematic review has been conducted to consolidate and analyze all available evidence to date. This systematic review and meta-analysis is the first to assess the association between TI and OS, and also considers patient risk and acquisition of TI post treatment. Methods: Comprehensive electronic searches were conducted in five key bibliographic databases. Relevant conference proceedings were searched electronically, experts were contacted, grey literature (national and international guidelines, unpublished and unindexed studies) was searched online, and the reference lists of relevant reviews and guidelines were checked. The protocol was published a priori on PROSPERO (ID CRD42014007264). Studies which recruited adults aged ≥ 18 years with confirmed MDS, and reported OS for TI versus transfusion-dependent (TD) pts were included. Any expression of OS and any definition of transfusion status (x transfusions per unit time) were acceptable. RCTs, cohort studies, consecutive case series ≥ 10 cases, before-after studies and case-control studies were eligible for inclusion. Where a hazard ratio (HR) was expressed for TD vs. TI, the ratio was converted by dividing 1 by the reported HR to obtain HR for TI vs. TD. A narrative synthesis and a random effects meta-analysis were conducted. The meta-analysis synthesised the multivariate HR for OS of TI compared with TD pts from non-overlapping cohorts. A random effects meta-regression assessed whether the effect of being TI on OS depends on the risk group (according to IPSS or WHO criteria) of the included pts. Results: Searches identified 1821 titles of which 89 were included, representing 60 separate analyses. Study quality (by the Quality in Prognosis Studies [QUIPS] criteria) was moderate overall, with some limitations in reporting of attrition, correction of confounders, and patient spectrum. Three types of studies were identified: a) recruited TD and TI pts and compared OS between groups (n = 45); b) recruited TD only, and compared those who became TI to those who remained TD after treatment (n = 8); c) recruited TD only, compared those with high transfusion burden to those with low (n = 7). Amongst type a studies (n = 45), TI was consistently associated with an OS benefit whether results were expressed as HRs or as other metrics such as mean survival. In a meta-analysis of all eligible type a studies (n = 11) a 57% decrease in the risk of death compared with TD pts (HR 0.43; 95% credible interval (CrI) 0.31 to 0.56) was estimated. When considering the impact of the risk category of pts through meta-regression (lower-risk and all-risk cohorts only; no higher-risk cohorts were eligible for inclusion), the coefficient of the interaction term was estimated to be HR 1.33 (95% CrI 0.6 to 2.98), which suggested that the magnitude of the benefit for pts being TI on OS was higher for all-risk groups. However, this effect was inconclusive. A meta-analysis of type b studies was not possible as study cohorts overlapped. The multivariate HR in the 3 type b studies which reported this ranged from 0.53 to 0.36, indicating a mortality reduction between 47% and 64% associated with acquisition of TI. Studies reporting other metrics also reported TI pts fared better. A meta-analysis of type c studies was neither planned nor conducted. All studies reported that pts with fewer transfusions per unit time demonstrated better OS than those with more, regardless of the high/low transfusion burden cut point used. Conclusion: A number of studies have previously suggested that MDS pts who are TI have better survival relative to those who are TD, but no meta-analysis has been conducted to date. Our findings revealed a consistent, substantial reduction in mortality among TI pts when compared with TD pts confirming the positive TI-OS association. A meta-regression analysis indicated that the impact of TI was higher in all-risk cohorts versus lower-risk cohorts, but this effect was not conclusive. A similar association was seen for those who acquired TI through treatment (Figure 1). Figure 1 Figure 1. Disclosures Harnan: Celgene Ltd: Research Funding. Ren:Celgene: Research Funding. Gomersall:Celgene Corporation: Research Funding. Everson-Hock:Celgene Ltd: Research Funding. Dhanasiri:Celgene Corp: Employment, Equity Ownership. Kulasekararaj:Celgene: Honoraria, Speakers Bureau; Alexion: Honoraria, Speakers Bureau.

scholarly journals Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

2018 ◽  
Vol 22 (4) ◽  
pp. 404-410 ◽  
Author(s):  
Tej D. Azad ◽  
Arjun V. Pendharkar ◽  
James Pan ◽  
Yuhao Huang ◽  
Amy Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Overall Survival ◽  
Histological Grade ◽  
Meta Analysis ◽  
Management Approach ◽  
Subtotal Resection ◽  
Low Grade ◽  
Intramedullary Spinal Cord ◽  
The Impact

OBJECTIVEPediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.METHODSThe authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.RESULTSTwenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.CONCLUSIONSThe authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.

P78 CRITICAL APPRAISAL OF THE IMPACT OF SURGICAL REPAIR OF TYPE II - IV PARAOESOPHAGEAL HERNIA ON PULMONARY IMPROVEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Boyle Charlie ◽  
Madhavan Anantha ◽  
Navidi Maziar ◽  
W Phillips Alexander
Keyword(s):  
Systematic Review ◽  
Surgical Repair ◽  
Meta Analysis ◽  
High Morbidity ◽  
Type Ii ◽  
Recurrence Rates ◽  
Conversion Rates ◽  
Patient Reported ◽  
Paraoesophageal Hernia ◽  
The Impact

Abstract Aim This systematic review and meta-analysis aimed at characterising impact of PEH repair on patient reported improvement in pulmonary symptoms Background Paraoesophageal hernia (PEH) comprising Type II - IV hiatal hernia often present with pulmonary symptoms such as shortness of breath. However, impact of surgical repair on improvement in pulmonary symptoms is unclear Methods This systematic review identified studies reported pulmonary symptoms in patients with undergoing surgical repair for Type II - IV PEH. Primary outcome was improvement in pulmonary symptoms. Secondary outcomes were improvement in other patient-reported outcomes such as heartburn, regurgitation, chest pain, and dysphagia and intraoperative and postoperative outcomes. Results This systematic review identified 27 studies, of which 21 studies were included in final meta-analysis. There was significant improvement in patient reported pulmonary symptoms following PEH repair (OR: 8.40, CI95%: 4.91 - 14.35, p<0.001), with improvement in all types of PEH. This was noticed in both patients who had noticed pulmonary symptoms prior to surgery and those that did not complain of these symptoms. Conclusion PEH repair is a major upper gastrointestinal procedure, which may be associated with high morbidity. However, pulmonary impairment from PEH warrant surgical repair with acceptable low laparoscopic conversion rates, morbidity, mortality and recurrence rates.

Sign in / Sign up

Export Citation Format

Share Document