scholarly journals Adjuvant Radiotherapy for Extrahepatic Cholangiocarcinoma: A Quality Assessment-Based Meta-Analysis

Liver Cancer ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 419-432
Author(s):  
Seo Hee Choi ◽  
Chai Hong Rim ◽  
In-Soo Shin ◽  
Won Sup Yoon ◽  
Woong Sub Koom ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Adjuvant Radiotherapy ◽  
Locoregional Recurrence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Extrahepatic Cholangiocarcinoma ◽  
Gastrointestinal Complications ◽  
Grade 3 ◽  
The Cochrane Library

<b><i>Introduction:</i></b> The benefits of adjuvant radiotherapy (ART) for extrahepatic cholangiocarcinoma are uncertain largely because existing publications lack clear comparisons between ART and non-ART arms. <b><i>Methods:</i></b> PubMed, Medline, Embase, and the Cochrane library were systematically searched until December 2020. The primary endpoint was overall survival (OS). Sensitivity analysis was performed for studies with reliable comparability (i.e., no favorable prognosticators in the ART arm that could skew the data). <b><i>Results:</i></b> Twenty-three studies involving 1,731 patients with extrahepatic cholangiocarcinoma were reviewed. The overall median of all median prescribed doses was 50.4 Gy; brachytherapy or an intraoperative boost of 10–21 Gy was applied in 5 studies. The pooled 1-, 3-, and 5-year OS rates in the non-ART and ART arms were 69.2% versus 81.0%, <i>p</i> = 0.035; 34.3% versus 44.7%, <i>p</i> = 0.025; 25.6% versus 31.7%, <i>p</i> = 0.115, respectively. The corresponding pooled locoregional recurrence rates were 52.1% versus 34.9% (<i>p</i> = 0.014). The pooled rate of grade ≥3 gastrointestinal complications was 9.8%. Sensitivity analysis performed on 14 eligible studies showed that the ART arms had a lower pooled R0 rate (36.8% vs. 63.2%, <i>p</i> = 0.02) and a higher rate of positive lymph nodes (47.4% vs. 34.9%, <i>p</i> = 0.08). The pooled 1-, 3-, and 5-year OS rates in the non-ART versus ART arms of the selected studies were 78.2% versus 84.9%, <i>p</i> = 0.143; 38.5% versus 49.2%, <i>p</i> = 0.026; and 27.8% versus 34.5%, <i>p</i> = 0.11, respectively. <b><i>Conclusions:</i></b> ART was shown to improve OS in all studies and in those selected for their reliable comparability.

Neoadjuvant chemotherapy regimens for triple-negative breast cancer: Insights from network meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12635-e12635
Author(s):  
Hirotaka Miyashita ◽  
Christina Cruz ◽  
Stephen C. Malamud
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Gastrointestinal Complications ◽  
Therapy Regimen ◽  
Neoadjuvant Systemic Therapy ◽  
Grade 3

e12635 Background: The best regimen for neoadjuvant chemotherapy for triple-negative breast cancer (TNBC) is unknown. Recent studies have shown promising data that adding carboplatin improves the rate of pathological complete response (pCR) in TNBC). Therefore, we performed a network meta-analysis to define the overall most effective neoadjuvant systemic therapy for TNBC. Methods: We searched MEDLINE, Cochrane Library, and EMBASE from inception to December 2019 for studies comparing the efficacy of different neoadjuvant regimens in patients with TNBC. We performed a network meta-analysis comparing the regimens in the selected studies using the random-effects model. We focused on anthracycline (A), bevacizumab (B), everolimus (E), and platinum salts (Pl) because these are the medications commonly added to taxane based regimens. All studies contained a taxane regimen. We analyzed the rate of pCR (ypT0/is, N0) and the incidence of grade 3-4 neutropenia, thrombocytopenia, nausea/vomiting, and diarrhea. Results: We identified a total of 13 randomized control trials for this analysis. We compared eight different classes of regimens. We found that regimens containing Pl were significantly superior to Pl non-containing regimens for the rate of pCR. (risk ratio (RR) for pCR [95% confidence interval (CI)]: 1.66 [1.19-2.31], 1.37 [1.14-1.64], and 1.36 [1.14-1.62] for no medications of special interest vs Pl, A vs A+Pl, and A+B vs A+B+Pl, respectively). Regimens containing B were associated with a significantly better rate of pCR. (RR for pCR [95% CI]: 1.24 [1.06-1.46] and 1.23 [1.01-1.51] for A vs A+B and A+Pl vs A+B+Pl, respectively) In contrast, adding A into the regimen did not improve the rate of pCR. In the safety analysis, regimens containing Pl were associated with a significantly higher incidence of grade 3-4 neutropenia and thrombocytopenia. Regimens containing B showed a higher incidence of grade 3-4 nausea/vomiting, and diarrhea. Conclusions: For TNBC, adding Pl or B into the neoadjuvant therapy regimen brings about a higher pCR rate, though they are associated with an increase in hematologic or gastrointestinal complications. The benefit of adding A to the neoadjuvant chemotherapy regimen for TNBC is not apparent.

scholarly journals Stereotactic arrhythmia radioablation (STAR) in patients with ventricular tachycardia: a meta-analysis of efficacy and safety outcomes.

2020 ◽  
Author(s):  
GUSTAVO Arruda Viani ◽  
Juliana Fernandes Pavoni ◽  
Ligia Issa de Fendi
Keyword(s):  
Ventricular Tachycardia ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Severe Toxicity ◽  
Efficacy And Safety ◽  
Small Series ◽  
Grade 3 ◽  
The Cochrane Library ◽  
Existing Data

Objectives: The effectiveness and safety of STAR in patients with refractory ventricular tachycardia (VT) to catheter ablation are limited to small series. We performed a meta-analysis of observational studies to summarize existing data about efficacy and toxicity following START for VT. Methods: Eligible studies were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through March 2020. We followed the PRISMA and MOOSE guidelines. An estimative of % VT burden reduction at 6 months higher than 85% was considered effective. A rate of any grade 3 or higher toxicity lower than 10% and no grade 4 or 5 were considered safe. Results: Four observational studies with a total of 39 patients treated were included. The % of VT burden reduction at 6 months was 91% (CI95% from 83 to 100%). The consumption of lower than 2 anti-arrhythmia drugs (AAD) at 6 months was 81%. The ejection fraction improved in 12.8%, unchanged 82%, and decreased by 5.2%. The overall survival (OS) was 92% and 82 % in 6 and 12 months. The cardiac death and disease-specific survival at 12 months were 12% and 88.5%. Late grade 3 toxicity 5% with no grade 4-5. Conclusion: STAR produced satisfactory % of VT burden reduction, with a significant reduction in the consumption of AAD at 6 months, and no severe toxicity. These findings support the continued work to develop new trials and to adopt STAR as a treatment option for medical practice.

scholarly journals Postoperative Adjuvant Radiotherapy in Atypical Meningioma Patients: A Meta-Analysis Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Dengpan Song ◽  
Dingkang Xu ◽  
Hongjie Han ◽  
Qiang Gao ◽  
Mingchu Zhang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Subtotal Resection ◽  
Free Survival ◽  
Simpson Grade ◽  
Atypical Meningiomas ◽  
The Cochrane Library ◽  
Grade Iii

Background and PurposeConsensus regarding the need for adjuvant radiotherapy (RT) in patients with atypical meningiomas (AMs) is lacking. We compared the effects of adjuvant RT after surgery, gross total resection (GTR), and subtotal resection (STR) on progression-free survival (PFS) and overall survival (OS) in patients with AMs, respectively.MethodsWe performed a systematic review and meta-analysis of the literature published in PubMed, Embase, and the Cochrane Library from inception to February 1, 2021, to identify articles comparing the PFS and OS of patients receiving postoperative RT after surgery, GTR and STR.ResultsWe identified 2307 unique studies; 24 articles including 3078 patients met the inclusion criteria. The sensitivity analysis results showed that for patients undergoing undifferentiated surgical resection, adjuvant RT reduced tumor recurrence (HR=0.70, p&lt;0.0001) with no significant effect on survival (HR=0.89, p=0.49). Postoperative RT significantly increased PFS (HR=0.69, p=0.01) and OS (HR=0.55, p=0.007) in patients undergoing GTR. The same improvement was observed in patients undergoing STR plus RT (PFS: HR=0.41, p&lt;0.00001; OS: HR=0.47, p=0.01). A subgroup analysis of RT in patients undergoing GTR showed no change in PFS in patients undergoing Simpson grade I and II resection (HR=1.82, p=0.22) but significant improvement in patients undergoing Simpson grade III resection (HR=0.64, p=0.02).ConclusionRegardless of whether GTR or STR was performed, postoperative RT improved PFS and OS to varying degrees. Especially for patients undergoing Simpson grade III or IV resection, postoperative RT confers the benefits for recurrence and survival.

scholarly journals Association between nonalcoholic fatty liver disease and extrahepatic cancers: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Shou-Sheng Liu ◽  
Xue-Feng Ma ◽  
Jie Zhao ◽  
Shui-Xian Du ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Fatty Liver Disease ◽  
Observational Studies ◽  
Meta Analysis ◽  
Colorectal Adenomas ◽  
Cochrane Library ◽  
Extrahepatic Cholangiocarcinoma ◽  
Nonalcoholic Fatty Liver ◽  
The Cochrane Library ◽  
Development Risk

Abstract Background NAFLD is tightly associated with various diseases such as diabetes, cardiovascular disease, kidney disease, and cancer. Previous studies had investigated the association between NAFLD and various extrahepatic cancers, but the available data to date is not conclusive. The aim of this study was to investigate the association between NAFLD and various extrahepatic cancers comprehensively. Methods Searches were conducted of various electronic databases (PubMed, EMBASE, Medline, and the Cochrane Library) to identify observational studies published between 1996 and January 2020 which investigated the association between NAFLD and extrahepatic cancers. The pooled OR/HR/IRR of the association between NAFLD and various extrahepatic cancers were analyzed. Results A total of 26 studies were included to investigate the association between NAFLD and various extrahepatic cancers. As the results shown, the pooled OR values of the risk of colorectal cancer and adenomas in patients with NAFLD were 1.72 (95%CI: 1.40-2.11) and 1.37 (95%CI: 1.29-1.46), respectively. The pooled OR values of the risk of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in patients with NAFLD were 2.46 (95%CI: 1.77-3.44) and 2.24 (95%CI: 1.58-3.17), respectively. The pooled OR value of the risk of breast cancer in patients with NAFLD was 1.69 (95%CI: 1.44-1.99). In addition, NAFLD was also tightly associated with the risk of gastric cancer, pancreatic cancer, prostate cancer, and esophageal cancer. Conclusions NAFLD could significantly increase the development risk of colorectal adenomas and cancer, intrahepatic and extrahepatic cholangiocarcinoma, breast, gastric, pancreatic, prostate, and esophageal cancer. NAFLD could be considered as one of the influencing factors during the clinical diagnosis and treatment for the extrahepatic cancers.

scholarly journals Association between nonalcoholic fatty liver disease and extrahepatic cancers: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Shou-Sheng Liu ◽  
Xue-Feng Ma ◽  
Jie Zhao ◽  
Shui-Xian Du ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Fatty Liver Disease ◽  
Observational Studies ◽  
Meta Analysis ◽  
Colorectal Adenomas ◽  
Cochrane Library ◽  
Extrahepatic Cholangiocarcinoma ◽  
Nonalcoholic Fatty Liver ◽  
The Cochrane Library ◽  
Development Risk

Abstract Background NAFLD is tightly associated with various diseases such as diabetes, cardiovascular disease, kidney disease, and cancer. Previous studies had investigated the association between NAFLD and various extrahepatic cancers, but the available data to date is not conclusive. The aim of this study was to investigate the association between NAFLD and various extrahepatic cancers comprehensively. Methods Searches were conducted of various electronic databases (PubMed, EMBASE, Medline, and the Cochrane Library) to identify observational studies published between 1996 and January 2020 which investigated the association between NAFLD and extrahepatic cancers. The pooled OR/HR/IRR of the association between NAFLD and various extrahepatic cancers were analyzed. Results A total of 26 studies were included to investigate the association between NAFLD and various extrahepatic cancers. As the results shown, the pooled OR values of the risk of colorectal cancer and adenomas in patients with NAFLD were 1.72 (95%CI: 1.40-2.11) and 1.37 (95%CI: 1.29-1.46), respectively. The pooled OR values of the risk of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in patients with NAFLD were 2.46 (95%CI: 1.77-3.44) and 2.24 (95%CI: 1.58-3.17), respectively. The pooled OR value of the risk of breast cancer in patients with NAFLD was 1.69 (95%CI: 1.44-1.99). In addition, NAFLD was also tightly associated with the risk of gastric cancer, pancreatic cancer, prostate cancer, and esophageal cancer. Conclusions NAFLD could significantly increase the development risk of colorectal adenomas and cancer, intrahepatic and extrahepatic cholangiocarcinoma, breast, gastric, pancreatic, prostate, and esophageal cancer. NAFLD could be considered as one of the influencing factors during the clinical diagnosis and treatment for the extrahepatic cancers.

scholarly journals Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shan Deng ◽  
Yonghao Yu
Keyword(s):  
Femur Fracture ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Rescue Analgesia ◽  
Block Level ◽  
Block Time ◽  
Sedation Scores ◽  
The Difference ◽  
The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

scholarly journals EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

2021 ◽  
pp. 174749302110042
Author(s):  
Grace Mary Turner ◽  
Christel McMullan ◽  
Olalekan Lee Aiyegbusi ◽  
Danai Bem ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Cochrane Library ◽  
Control Group ◽  
Large Sample Size ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

scholarly journals Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jae Young Moon ◽  
Min Ro Lee ◽  
Gi Won Ha
Keyword(s):  
Rectal Cancer ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Recurrence ◽  
Oncologic Outcomes ◽  
Cochrane Library ◽  
Transanal Total Mesorectal Excision ◽  
Random Effects Models ◽  
The Cochrane Library

Abstract Background Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. Methods PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. Results We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39–1.09, I2 = 0%), 0.79 (95% CI 0.57–1.10, I2 = 0%), 1.14 (95% CI 0.44–2.91, I2 = 66%), and 0.75 (95% CI 0.40–1.41, I2 = 0%), respectively. Conclusion In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.

scholarly journals Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

2021 ◽  
Author(s):  
Wenju Zhang ◽  
Willy Cecilia Cheon ◽  
Li Zhang ◽  
Xiaozhong Wang ◽  
Yuzhen Wei ◽  
...  
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Sacrospinous Ligament ◽  
Gastrointestinal Complications ◽  
Sacrospinous Ligament Fixation ◽  
Apical Support ◽  
Abdominal Sacrocolpopexy

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

Appendectomy Does Not Increase the Risk of Future Emergence of Parkinson’s Disease: A Meta-analysis

2021 ◽  
pp. 000313482198903
Author(s):  
Mitsuru Ishizuka ◽  
Norisuke Shibuya ◽  
Kazutoshi Takagi ◽  
Hiroyuki Hachiya ◽  
Kazuma Tago ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Significant Difference ◽  
The Cochrane Library ◽  
The Impact ◽  
The Relationship ◽  
Observation Period

Objective To explore the impact of appendectomy history on emergence of Parkinson’s disease (PD). Background Although there are several studies to investigate the relationship between appendectomy history and emergence of PD, the results are still controversial. Methods We performed a comprehensive electronic search of the literature (the Cochrane Library, PubMed, and the Web of Science) up to April 2020 to identify studies that had employed databases allowing comparison of emergence of PD between patients with and those without appendectomy history. To integrate the impact of appendectomy history on emergence of PD, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI) for the selected studies, and heterogeneity was analyzed using I2 statistics. Results Four studies involving a total of 6 080 710 patients were included in this meta-analysis. Among 1 470 613 patients with appendectomy history, 1845 (.13%) had emergences of PD during the observation period, whereas among 4 610 097 patients without appendectomy history, 6743 (.15%) had emergences of PD during the observation period. These results revealed that patients with appendectomy history and without appendectomy had almost the same emergence of PD (RR, 1.02; 95% CI, .87-1.20; P = .83; I2 = 87%). Conclusion This meta-analysis has demonstrated that there was no significant difference in emergence of PD between patients with and those without appendectomy history.

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