Nicht kleinzelliges Lungenkarzinom bei älteren Patienten: Einfluss von Lobektomie oder sublobärer Resektion auf die Prognose

Background: We present a critical comparison of lobectomy and sub-lobar resection in elderly patients with early stage non-small cell lung cancer using meta-analytical techniques. Methods: A literature search was conducted between the period of December 1997 to March 2019 to identify the comparative studies evaluating 1-, 3-, and 5-year survival rates. The pooled odds ratios (OR) and the 95% confidence intervals (95% CI) were calculated with either the fixed or random effect models, respectively. Results: Six retrospective studies are included in our meta-analysis for a total of 1205 patients. 843 of the individuals were treated with lobectomy, while 362 were treated with sub-lobar resection. We found no significant difference between the lobectomy and the sub-lobar resection in either of the 1-, 3-, or 5-year survival rates. Conclusions: This study suggests that in elderly individuals with stage I NSCLC, a sub-lobar resection is statistically equivalent to the lobectomy in terms of 1-, 3-, and 5-year survival rates. Further large-scale randomized studies are needed to confirm our results.

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Simultaneous implant placement with autogenous onlay bone grafts: a systematic review and meta-analysis

International Journal of Implant Dentistry ◽

10.1186/s40729-021-00311-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Guoqiang Ma ◽

Chaoan Wu ◽

Miaoting Shao

Keyword(s):

Meta Analysis ◽

Survival Rates ◽

Bone Grafts ◽

Implant Survival ◽

Analysis Model ◽

Implant Placement ◽

Significant Difference ◽

Delayed Implant Placement ◽

Onlay Grafts

AbstractSeveral authors have suggested that implants can be placed simultaneously with onlay bone grafts without affecting outcomes. Therefore, the purpose of this study was to answer the following clinical questions: (1) What are the outcomes of implants placed simultaneously with autogenous onlay bone grafts? And (2) is there a difference in outcomes between simultaneous vs delayed placement of implants with autogenous onlay bone grafts? Databases of PubMed, Embase, and Google Scholar were searched up to 15 November 2020. Data on implant survival was extracted from all the included studies (single arm and comparative) to calculate point estimates with 95% confidence intervals (CI) and pooled using the DerSimonian–Laird meta-analysis model. We also compared implant survival rates between the simultaneous and delayed placement of implants with data from comparative studies. Nineteen studies were included. Five of them compared simultaneous and delayed placement of implants. Dividing the studies based on follow-up duration, the pooled survival of implant placed simultaneously with onlay grafts after <2.5 years of follow-up was 93.1% (95% CI 82.6 to 97.4%) and after 2.5–5 years was 86% (95% CI 78.6 to 91.1%). Implant survival was found to be 85.8% (95% CI 79.6 to 90.3%) with iliac crest grafts and 95.7% (95% CI 83.9 to 93.0%) with intra-oral grafts. Our results indicated no statistically significant difference in implant survival between simultaneous and delayed placement (OR 0.43, 95% 0.07, 2.49, I2=59.04%). Data on implant success and bone loss were limited. Data indicates that implants placed simultaneously with autogenous onlay grafts have a survival rate of 93.1% and 86% after a follow-up of <2.5 years and 2.5–5years respectively. A limited number of studies indicate no significant difference in implant survival between the simultaneous and delayed placement of implants with onlay bone grafts. There is a need for randomized controlled trials comparing simultaneous and delayed implant placement to provide robust evidence.

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Age-Related Biology of Early-Stage Operable Breast Cancer and Its Impact on Clinical Outcome

Cancers ◽

10.3390/cancers13061417 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1417

Author(s):

Binafsha M. Syed ◽

Andrew R. Green ◽

Emad A. Rakha ◽

David A.L. Morgan ◽

Ian O. Ellis ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Histological Grade ◽

Survival Rates ◽

Growth Factor Receptor ◽

Progesterone Receptors ◽

Biological Characteristics ◽

Cancer Specific Survival ◽

Age Related ◽

Significant Difference

As age advances, breast cancer (BC) tends to change its biological characteristics. This study aimed to explore the natural progression of such changes. The study included 2383 women with clinically T0-2N0-1M0 BC, managed by primary surgery and optimal adjuvant therapy in a dedicated BC facility. Tissue micro-arrays were constructed from their surgical specimens and indirect immunohistochemistry was used for analysis of a large panel (n = 16) of relevant biomarkers. There were significant changes in the pattern of expression of biomarkers related to luminal (oestrogen receptor (ER), progesterone receptors (PgR), human epidermal growth factor receptor (HER-2), E-cadherin, MUC1, bcl2 CK7/8, CK18 and bcl2) and basal (CK5/6, CK14, p53 and Ki67) phenotypes, lymph node stage, histological grade and pathological size when decade-wise comparison was made (p < 0.05). The ages of 40 years and 70 years appeared to be the milestones marking a change of the pattern. There were significantly higher metastasis free and breast cancer specific survival rates among older women with ER positive tumours while there was no significant difference in the ER negative group according to age. Biological characteristics of BC show a pattern of change with advancing age, where 40 years and 70 years appear as important milestones. The pattern suggests <40 years as the phase with aggressive phenotypes, >70 years as the less aggressive phase and 40–70 years being the transitional phase.

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Staged angioplasty: A sensible approach to prevent hyperperfusion syndrome after carotid artery stenting? A meta-analysis

Interventional Neuroradiology ◽

10.1177/15910199211018328 ◽

2021 ◽

pp. 159101992110183

Author(s):

Bingyang Zhao ◽

Xinzhao Jiang ◽

Pei Wang ◽

Zhongyu Zhao ◽

Jing Mang ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Random Effect ◽

Thromboembolic Events ◽

Current Recommendation ◽

Hyperperfusion Syndrome ◽

Asian Populations ◽

Significant Difference ◽

Vessel Dissection

Objective To investigate whether staged angioplasty (SAP) is a safe and effective treatment to prevent hyperperfusion syndrome after carotid artery stenting (CAS). Methods A systematic literature search was performed according to established criteria to identify eligible articles published before October 2020. Pooled dichotomous data were presented as odds ratios (OR) and corresponding 95% confidence intervals (CI) using random-effect models. The efficacy endpoints were hyperperfusion syndrome (HPS), hyperperfusion phenomenon (HPP), and intracerebral hemorrhage (ICH). The safety endpoint was post-procedural thromboembolic events. The feasibility of the procedure was assessed by device-related adverse events (vessel dissection and failed angioplasty) in SAP. Results Ten studies (1030 participants) were eligible. SAP was superior to regular CAS in preventing HPS (OR = 0.35, 95% CI 0.14–0.86, P = 0.02). There was no significant difference in the rate of thromboembolic events between the SAP group and the regular CAS group. The rates of vessel dissection and failed angioplasty with the use of a 3.0-mm-diameter balloon were 5.4% and 0.4%, respectively. Conclusion SAP may reduce the incidence of post-CAS HPS without increasing procedure-related complications. A 3.0-mm-diameter balloon used in SAP may be appropriate for Asian populations. However, the confounded study design and confused definitions of reporting items hinder the current recommendation of SAP in clinical use.

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LO84: The incidence of fall-related intracranial bleeding in older adults taking anticoagulants, antiplatelets and neither medication: a meta-analysis

CJEM ◽

10.1017/cem.2020.138 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S38-S38

Author(s):

K. de Wit ◽

D. Nishijima ◽

S. Mason ◽

R. Jeanmonod ◽

S. Parpia ◽

...

Keyword(s):

Older Adults ◽

Meta Analysis ◽

Grey Literature ◽

Random Effect ◽

Intracranial Bleeding ◽

Inclusion Criteria ◽

Antiplatelet Medication ◽

Cochrane Database ◽

Random Effect Models ◽

Anticoagulant Medication

Introduction: It is unclear whether anticoagulant or antiplatelet medications increase the risk for intracranial bleeding in older adults after a fall. Our aim was to report the incidence of intracranial bleeding among older adults presenting to the emergency department (ED) with a fall, among patients taking anticoagulants, antiplatelet medications, both medications and neither medication. Methods: This was a systematic review and meta-analysis, PROSPERO reference CRD42019122626. Medline, EMBASE (via OVID 1946 - July 2019), Cochrane, Database of Abstracts of Reviews of Effects databases and the grey literature were searched for studies reporting on older adults who were evaluated after a fall. We included prospective studies conducted in the ED where more than 80% of the cohort were 65 years or older and had fallen. We contacted study authors for aggregate data on intracranial bleeding in patients prescribed anticoagulant medication, antiplatelet medication and neither medication. Incidences of intracranial bleeding were pooled using random effect models, and I2 index was used to assess heterogeneity. Results: From 7,240 publication titles, 10 studies met inclusion criteria. The authors of 8 of these 10 studies provided data (on 9,489 patients). All studies scored low or moderate risk of bias. The pooled incidence of intracranial bleeding among patients taking an anticoagulant medication was 5.1% (n = 5,016, 95% Confidence Interval (CI): 4.1 to 6.3%) I2 = 42%, a single antiplatelet 6.4% (n = 2,148, 95% CI: 5.4 to 7.6%) I2 = 75%, both anticoagulant and antiplatelet medications 5.9% (n = 212, 95% CI: 1.3 to 13.5%) I2 = 72%, and neither of these medications 4.8% (n = 1,927, 95% CI: 3.5 to 6.2%) I2 = 50%. A sensitivity analysis restricted to patients who had a head CT in the ED reported incidences of 6.1% (n = 3,561, 95% CI: 3 to 8.3%), 8.4% (n = 1,781, 95% CI: 5.5 to 11.8%), 6.7% (n = 206, 95% CI 1.5 to 15.2%) and 6.6% (n = 1,310, 95% CI: 5.0 to 8.4%) respectively. Conclusion: The incidence of fall-related intracranial bleeding in older ED patients was similar among patients who take anticoagulant medication, antiplatelet medication, both and neither medication, although there was heterogeneity between study findings.

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Systematic review of adjuvant therapy for early stage (epithelial) ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200307000-00001 ◽

2003 ◽

Vol 13 (4) ◽

pp. 395-404 ◽

Cited By ~ 7

Author(s):

B. Winter-Roach ◽

L. Hooper ◽

H. Kitchener

Keyword(s):

Systematic Review ◽

Ovarian Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Early Stage ◽

Meta Analysis ◽

Disease Free Survival ◽

Significant Difference ◽

Well Differentiated ◽

Platinum Chemotherapy

A systematic review and meta analysis has been undertaken in order to evaluate the effectiveness of adjuvant therapy following surgery for early ovarian cancer. Trials reported since 1990 have been of a higher quality enabling a meta analysis of adjuvant chemotherapy vs adjuvant radiotherapy and a meta analysis of adjuvant chemotherapy vs observation. There was no significant difference between radiotherapy and chemotherapy, though these comprised studies which demonstrated considerable heterogeneity. Chemotherapy did confer significant benefit over observation in terms of both overall and disease free survival. Except for women in whom adequate surgical staging has revealed well differentiated disease confined to one or both ovaries with intact capsule, platinum chemotherapy should be offered to reduce risk of recurrence.

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Correlation between Methylenetetrahydrofolate Reductase Polymorphisms and Hepatocellular Carcinoma: A Meta-Analysis

Annals of Nutrition and Metabolism ◽

10.1159/000496428 ◽

2019 ◽

Vol 74 (3) ◽

pp. 251-256 ◽

Cited By ~ 1

Author(s):

Hailong Su ◽

Guo Zhang

Keyword(s):

Hepatocellular Carcinoma ◽

Gene Polymorphisms ◽

Methylenetetrahydrofolate Reductase ◽

Meta Analysis ◽

Random Effect ◽

Recessive Model ◽

Mthfr Gene ◽

Systematic Research ◽

The Relationship ◽

Random Effect Models

Background: The correlation between methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and hepatocellular carcinoma (HCC) remains controversial. Objectives: We performed this study to better assess the relationship between MTHFR gene polymorphisms and the likelihood of HCC. Methods: A systematic research of PubMed, Medline, and Embase was performed to retrieve relevant articles. ORs and 95% CIs were calculated. Results: A total of 15 studies with 8,378 participants were analyzed. In overall analyses, a significant association with the likelihood of HCC was detected for the rs1801131 polymorphism with fixed-effect models (FEMs) in recessive comparison (p = 0.002, OR 0.62, 95% CI 0.43–0.82). However, no positive results were detected for the rs1801133 polymorphism in any comparison. Further subgroup analyses revealed that the rs1801131 polymorphism was significantly associated with the likelihood of HCC in Asians with both FEMs (recessive model: p < 0.0001, OR 0.42, 95% CI 0.29–0.62; allele model: p = 0.004, OR 1.20, 95% CI 1.06–1.35) and random-effect models (recessive model: p = 0.002, OR 0.47, 95% CI 0.29–0.75). Nevertheless, we failed to detect any significant correlation between the rs1801133 polymorphism and HCC. Conclusions: Our findings indicated that the rs1801131 polymorphism may serve as a genetic biomarker of HCC in Asians.

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Tryptophan Catabolites in Bipolar Disorder: A Meta-Analysis

Frontiers in Immunology ◽

10.3389/fimmu.2021.667179 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kaat Hebbrecht ◽

Katrien Skorobogatov ◽

Erik J. Giltay ◽

Violette Coppens ◽

Livia De Picker ◽

...

Keyword(s):

Bipolar Disorder ◽

Cerebrospinal Fluid ◽

Methodological Quality ◽

Meta Analysis ◽

Random Effect ◽

Healthy Controls ◽

Significant Difference ◽

Subgroup Analyses ◽

Tryptophan Catabolites

ObjectiveTryptophan catabolites (TRYCATs) are implicated in the pathophysiology of mood disorders by mediating immune-inflammation and neurodegenerative processes. We performed a meta-analysis of TRYCAT levels in bipolar disorder (BD) patients compared to healthy controls.MethodsA systematic literature search in seven electronic databases (PubMed, Embase, Web of Science, Cochrane, Emcare, PsycINFO, Academic Search Premier) was conducted on TRYCAT levels in cerebrospinal fluid or peripheral blood according to the PRISMA statement. A minimum of three studies per TRYCAT was required for inclusion. Standardized mean differences (SMD) were computed using random effect models. Subgroup analyses were performed for BD patients in a different mood state (depressed, manic). The methodological quality of the studies was rated using the modified Newcastle-Ottawa Quality assessment Scale.ResultsTwenty-one eligible studies were identified. Peripheral levels of tryptophan (SMD = -0.44; p < 0.001), kynurenine (SMD = - 0.3; p = 0.001) and kynurenic acid (SMD = -.45; p = < 0.001) were lower in BD patients versus healthy controls. In the only three eligible studies investigating TRP in cerebrospinal fluid, tryptophan was not significantly different between BD and healthy controls. The methodological quality of the studies was moderate. Subgroup analyses revealed no significant difference in TRP and KYN values between manic and depressed BD patients, but these results were based on a limited number of studies.ConclusionThe TRYCAT pathway appears to be downregulated in BD patients. There is a need for more and high-quality studies of peripheral and central TRYCAT levels, preferably using longitudinal designs.

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Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18039 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18039-e18039

Author(s):

Sondos Zayed ◽

Cindy Lin ◽

Gabriel Boldt ◽

Pencilla Lang ◽

Nancy Read ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Treatment Approach ◽

Early Stage ◽

Meta Analysis ◽

Cochrane Library ◽

Size Analysis ◽

Survival Outcomes ◽

Curative Intent ◽

Significant Difference

e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.

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Prevalence of HTN in Iran: Meta-analysis of Published Studies in 2004-2018

Current Hypertension Reviews ◽

10.2174/1573402115666190118142818 ◽

2019 ◽

Vol 15 (2) ◽

pp. 113-122

Author(s):

Mehdi Jafari Oori ◽

Farahnaz Mohammadi ◽

Kian Norozi ◽

Masoud Fallahi-Khoshknab ◽

Abbas Ebadi ◽

...

Keyword(s):

Sample Size ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Effect Model ◽

Significant Difference ◽

Standard Tool ◽

Egger Test ◽

Significant Health

Introduction: Prevalence of hypertension (HTN) is increasing in the developing countries like Iran. Various studies have reported different rates of HTN in Iran. The purpose of this study was to estimate an overall prevalence of HTN in Iran. Methodology: Using the English and Persian key derived from Mesh, the databases including MagIran, Iran Medex, SID, Web of Sciences, PubMed, Science Direct and Google Scholar as a searching engine were reviewed: from 2004 to 2018. The overall prevalence of MA was estimated using Random effect model. The I2 test was used to assess the heterogeneity of the studies. Additionally, the quality of studies was evaluated using a standard tool. Publication bias was conducted with the Egger test. Meta-regression and analysis of subgroups were analyzed based on variables such as age, marital status, region and tools. Data were analyzed using STATA 12 software. Results: Analysis of 58 primary articles with a sample size of 902580 showed that the prevalence of HTN in Iran was 25% (with 95% CI of 22-28). The highest prevalence of HTN was related to elderly (42%). The prevalence of HTN was 25% (95% CI: 19-31) in women and 24% (95% CI: 20-28) in men with no significant difference (p = 0.758). The results also indicated that the prevalence of HTN was not related to the year of studies (p = 0.708) or sample size (p = 769). Conclusion: Despite the advancements in science and technology, along with health and prevention of diseases, the overall prevalence of HTN raised in Iran. Since HTN is a silent disease with significant health consequences and economic burden, programs designed to better HTN control seem vital to enhance community health.

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Aspirin Exposure and Mortality Risk among Prostate Cancer Patients: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/9379602 ◽

2019 ◽

Vol 2019 ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Lai lai Fan ◽

Cheng Peng Xie ◽

Yi Ming Wu ◽

Xi jie Gu ◽

Ying he Chen ◽

...

Keyword(s):

Prostate Cancer ◽

Frequency Response ◽

Mortality Risk ◽

Meta Analysis ◽

Random Effect ◽

Response Analysis ◽

Dose Frequency ◽

All Cause Mortality ◽

Cancer Specific Mortality ◽

Random Effect Models

Background. Prostate cancer (PCa) is the ninth most common cause of cancer death globally. Many studies have investigated aspirin exposure and mortality risk among PCa patients, returning inconsistent results. We conducted a comprehensive meta-analysis to explore the association between aspirin exposure and mortality risk among PCa patients and to investigate potential dose/duration/frequency-response relationships. Methods and Results. Studies published from 1980 to 2018 of PubMed and EMBASE databases were searched. We included 14 studies with 110,000 participants. Multivariate-adjusted odds ratios (ORs) were pooled using random-effect models. Potential dose/duration/frequency-response relationships were evaluated for aspirin exposure and prostate cancer-specific mortality (PCSM) risk. We did not detect an association between the highest aspirin exposure and mortality risk (PCSM of prediagnostic aspirin exposure, OR: 0.96, 95% confidence interval [CI]: 0.87-1. 07, I2 = 0%; PCSM of postdiagnostic aspirin exposure, OR:0.92, 95% CI: 0.77-1.10, I2 = 56.9%; all-cause mortality [ACM] of prediagnostic aspirin exposure, OR: 0.96, 95% CI: 0.88-1.04, I2 = 9.4%; ACM of postdiagnostic aspirin exposure, OR: 0.95, 95% CI: 0.73-1.23, I2 = 88.9%). There was no significant dose/frequency-response association observed for aspirin exposure and PCSM risk. On duration-response analysis, we found that short-term postdiagnostic aspirin exposure (shorter than 2.5 years) increased the risk of PCSM. Conclusions. Our meta-analysis suggests that there is no association between aspirin exposure and PCSM risk. Nor is there an association between the highest aspirin exposure and ACM risk among PCa patients. More studies are needed for a further dose/duration/frequency-response meta-analysis.

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