Short-term (ST) versus long-term (LT) hormone treatment (HT) in combination with radiotherapy (RT) for locally advanced prostate cancer (LAPC): Meta-analysis of randomized trials (RCTs)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5128-5128
Author(s):  
F. Cuppone ◽  
E. Bria ◽  
D. Giannarelli ◽  
M. Milella ◽  
E. M. Ruggeri ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Locally Advanced ◽  
Random Effect Model ◽  
Hormone Treatment ◽  
Significant Heterogeneity ◽  
Cancer Specific Survival ◽  
Relative Risks ◽  
Number Of Patients ◽  
Meta Regression Analysis

5128 Background: Hormone suppression plus RT is able to significantly decrease the recurrences and the mortality of patients (pts) affected by LAPC. In order to determine if difference exists between ST-HT (HT ≤6 months), and LT-HT (HT ≥8 months) in combination with RT for LAPC, a literature-based meta-analysis was conducted. Methods: Event-based relative risks (RR) with 95% confidence intervals (CI) were derived through a random-effect model. Differences in primary (biochemical failure, BF, and cancer-specific survival, CSS), and secondary outcomes (overall survival, OS, and pattern of recurrence, local or distant, LR/DM) were explored. Absolute differences (AD) and the number of patients needed to treat (NNT) were calculated. Heterogeneity test, a meta-regression analysis with clinico-pathological predictors for outcomes and a correlation analysis for surrogate end-points were conducted as well. Results: Four trials (3,148 patients) were gathered. Data were available for all RCTs only for BF; patient population ranged from 297 to 1,521 pts. Three predictors were identified: median PSA (range 9.5–20.35), Gleason score 7–10 (27–55% pts/trial) and T3–4 (13–77% pts/trial). None of the selected predictors did significantly affect any outcomes. A significant correlation and trend between the log of the BF-RR and DM and OS were found (p=0.029 and p=0.07, respectively). Conclusions: Although with significant heterogeneity (reflecting different patient’ risk stratifications), LT-HT seems to significantly decrease biochemical, local and distant recurrences, and increase cancer specific survival in comparison with ST-HT. Balancing these advantages with toxicities and costs represents the next step of the current analysis. [Table: see text] No significant financial relationships to disclose.

scholarly journals Abdominal obesity and gastroesophageal cancer risk: systematic review and meta-analysis of prospective studies

2017 ◽  
Vol 37 (3) ◽  
Author(s):  
Xuan Du ◽  
Khemayanto Hidayat ◽  
Bi-Min Shi
Keyword(s):  
Esophageal Cancer ◽  
Abdominal Obesity ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Final Analysis ◽  
Gastric Cardia Adenocarcinoma ◽  
Gastroesophageal Cancer ◽  
Relative Risks ◽  
Increased Risk

To systematically and quantitatively review the relation of abdominal obesity, as measured by waist circumference (WC) and waist to hip ratio (WHR), to total gastroesophageal cancer, gastric cancer (GC), and esophageal cancer. PubMed and Web of Science databases were searched for studies assessing the association between abdominal obesity and gastroesophageal cancer (GC and/or esophageal cancer) up to August 2016. A random-effect model was used to calculate the summary relative risks (RRs) and 95% confidence intervals (CIs). Seven prospective cohort studies – one publication included two separate cohorts – from six publications were included in the final analysis. A total of 2130 gastroesophageal cancer cases diagnosed amongst 913182 participants. Higher WC and WHR were significantly associated with increased risk of total gastroesophageal cancer (WC: RR 1.68, 95% CI: 1.38, 2.04; WHR: RR 1.49, 95% CI: 1.19, 1.88), GC (WC: RR 1.48, 95% CI: 1.24, 1.78; WHR: 1.33, 95% CI: 1.04, 1.70), and esophageal cancer (WC: RR 2.06, 95% CI: 1.30, 3.24; WHR: RR 1.99, 95% CI: 1.05, 3.75).Findings from our subgroup analyses showed non-significant positive associations between gastric non-cardia adenocarcinoma (GNCA) and both measures of abdominal adiposity, while gastric cardia adenocarcinoma (GCA) was positively associated with WC but not with WHR. On analysis restricted to studies that adjusted for body mass index (BMI), WC was positively associated with GC and esophageal cancer, whereas WHR was positively associated with risk of GC only. Although limited, the findings from our meta-analysis suggest the potential role of abdominal obesity in the etiology of gastric and esophageal cancers.

scholarly journals Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Berta ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data

2019 ◽  
Vol 42 (2) ◽  
pp. e150-e157 ◽  
Author(s):  
R Gupta ◽  
S Gupta ◽  
S Sharma ◽  
D N Sinha ◽  
R Mehrotra
Keyword(s):  
Smokeless Tobacco ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Group Analysis ◽  
Chewing Tobacco ◽  
Fatal Stroke ◽  
Relative Risks ◽  
Study Characteristics ◽  
Gender Based

Abstract Background The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. Methods A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. Results The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 1.34 times or 13.4% higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. Conclusion The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke.

scholarly journals PREVALENCE OF INJURIES IN BRAZILIAN RECREATIONAL STREET RUNNERS: META-ANALYSIS

2019 ◽  
Vol 25 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Wyngrid Porfirio Borel ◽  
José Elias Filho ◽  
Juliano Bergamaschine Mata Diz ◽  
Poliana Fernandes Moreira ◽  
Priscila Monteiro Veras ◽  
...  
Keyword(s):  
Associated Factors ◽  
Low Cost ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Knee Injuries ◽  
Muscle Injuries ◽  
Level Of Evidence ◽  
Meta Regression Analysis ◽  
Type Of Injury

ABSTRACT Street running is an accessible, low-cost form of exercise. However, the occurrence of musculoskeletal injuries may hinder regular practice. This study aimed at estimating the prevalence of injuries in Brazilian street runners and the associated factors. A meta-analysis of Brazilian studies was performed to investigate the prevalence and risk factors of injuries in male and female recreational street runners aged ≥18 years. We excluded systematic review studies, research conducted on professional athletes or triathletes, and duplicate articles. The following databases were used: SciELO, LILACS, PubMed, Web of Science, and Google Scholar. Keywords such as “prevalence,” “injury,” “recreational street runners,” and “Brazil” were used. Prevalence analysis was performed using the random effect model, and a funnel plot was used to assess publication bias. Then the Begg-Mazumdar and Egger tests were applied to quantify the graph results. The Prevalence Critical Appraisal Instrument was used to evaluate the methodological quality of the studies. Associated factors were analyzed with meta-regression analysis. Twenty-three studies with 3,786 runners were included in the review. The prevalence of injury was 36.5% (95% confidence interval [CI] 30.8-42.5%), and a running distance per week greater than 20 km was a predictive variable of injuries. A higher prevalence of injuries was observed in men than in women (28.3%, 95% CI 22.5-35.0%), the knee was the most affected site of injury (32.9%, 95% CI 26.7-39.6%), and muscle injuries were the most frequent type of injury (27.9%, 95% CI 18.2-40.1%). This is the first national meta-analysis conducted to investigate the prevalence of injuries in recreational street runners. Although the prevalence of injuries was moderate, caution is required in terms of the weekly duration of running. Male runners are more susceptible, and muscle and knee injuries are the most common. Level of evidence II, Systematic reviewb of Level II Studies.

How much is reasonable to expect about overall survival (OS) benefit when designing studies with new drugs for patients affected by castration resistant prostate cancer (CRPC)? Meta-analysis of 23 randomized clinical trials (RCT) including 17,640 patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16053-e16053
Author(s):  
Francesco Massari ◽  
Francesca Maines ◽  
Sara Pilotto ◽  
Camillo Porta ◽  
Paolo Carlini ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Significant Interaction ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Phase Iii ◽  
Sensitivity Analyses ◽  
Significant Heterogeneity ◽  
Significant Difference

e16053 Background: Treatment decision making in patients affected by CRPC is difficult because the numerous available therapeutic opportunities can significantly affect OS. To demonstrate that comparing results in absence of head-to-head studies may lead to biased survival estimations, a literature-based meta-analysis was conducted. Methods: Hazard Ratios (HR) with 95% confidence intervals (CI) were extracted and cumulated according to a random-effect model from phase III trials. Sensitivity analyses were performed according to: 1) Treatment Strategy (TS, Chemotherapy versus Hormonal versus Immunotherapy versus Other), 2) Comparison (Chemotherapy versus Placebo versus Other), and 3) Disease setting with regard to treatment with Docetaxel (DOC),. Testing for heterogeneity was performed as well. Results: A significant heterogeneity for the 3 sensitivity analyses was found (p<0.0001). The cumulative HR in favor of (any) experimental arm was 0.91 (95% CI 0.84-0.99, p=0.028). We found a significant interaction according to the chosen TS (p<0.0001), in fact a significant difference in OS was more likely to be detected in RCT evaluating hormonal drugs (HR 0.76, 95% CI 0.64-0.92, p=0.005) versus studies testing immunotherapy (HR 1.16, 95% CI 0.86-1.56, p=0.31). With regard to Comparison, a significant interaction (p<0.0001) was found in favor of RCT having placebo as control (HR 0.86, 95% CI 0.76-0.97, p=0.015), versus studies evaluating chemotherapy (HR 1.00, 95% CI 0.84, 1.19, p=0.99). A significant interaction according to DOC-treatment was also detected (p<0.0001), being the Post-DOC the Setting where a significant OS benefit was more likely to be determined (HR 0.77, 95% CI 0.66-0.90, p=0.001). Conclusions: The cross-trials interpretation in absence of formal direct comparisons may drive biased conclusions with regard to OS estimation. When designing trials to evaluate drugs (or strategies) in CRPC, the expected OS benefit must take into account the comparator, the treatment strategy and the (eventual) pre-treatment with DOC.

scholarly journals β lactam monotherapy versus β lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials

BMJ ◽  
2004 ◽  
Vol 328 (7441) ◽  
pp. 668 ◽  
Author(s):  
Mical Paul ◽  
Ishay Benuri-Silbiger ◽  
Karla Soares-Weiser ◽  
Leonard Leibovici
Keyword(s):  
Relative Risk ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Randomised Trials ◽  
Intention To Treat ◽  
Relative Risks ◽  
Development Of Resistance

AbstractObjective To compare β lactam monotherapy with β lactam-aminoglycoside combination therapy for severe infections.Data sources Medline, Embase, Lilacs, Cochrane Library, and conference proceedings, to 2003; references of included studies; contact with all authors. No restrictions, such as language, year of publication, or publication status.Study selection All randomised trials of β lactam monotherapy compared with β lactam-aminoglycoside combination therapy for patients without neutropenia who fulfilled criteria for sepsis.Data selection Two reviewers independently applied selection criteria, performed quality assessment, and extracted the data. The primary outcome assessed was all cause fatality by intention to treat. Relative risks were pooled with the random effect model (relative risk < 1 favours monotherapy).Results 64 trials with 7586 patients were included. There was no difference in all cause fatality (relative risk 0.90, 95% confidence interval 0.77 to 1.06). 12 studies compared the same β lactam (1.02, 0.76 to 1.38), and 31 studies compared different β lactams (0.85, 0.69 to 1.05). Clinical failure was more common with combination treatment overall (0.87, 0.78 to 0.97) and among studies comparing different β lactams (0.76, 0.68 to 0.86). There was no advantage to combination therapy among patients with Gram negative infections (1835 patients) or Pseudomonas aeruginosa infections (426 patients). There was no difference in the rate of development of resistance. Nephrotoxicity was significantly more common with combination therapy (0.36, 0.28 to 0.47). Heterogeneity was not significant for these comparisons.Conclusions In the treatment of sepsis the addition of an aminoglycoside to β lactams should be discouraged. Fatality remains unchanged, while the risk for adverse events is increased.

The efficacy of drug treatments for dysthymia: a systematic review and meta-analysis

1999 ◽  
Vol 29 (6) ◽  
pp. 1273-1289 ◽  
Author(s):  
M. S. DE LIMA ◽  
M. HOTOPH ◽  
S. WESSELY
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Common Mental Disorder ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dysthymic Disorder ◽  
Number Needed To Treat ◽  
Relative Risks ◽  
Co Morbidity ◽  
Drug Treatments

Background. Dysthymia is a common mental disorder, associated with considerable disability and high co-morbidity. This review assessed the role of pharmacological treatment.Methods. All randomized-controlled trials that compared active drug versus placebo for dysthymic patients were included. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with the Random Effect Model method. Where possible, number needed to treat and number needed to harm were estimated.Results. Fifteen trials were included for the main comparisons. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR treatment response was 0·68 (95% CI 0·59–0·78) for TCA, 0·64 (95% CI 0·55–0·74) for SSRIs, 0·59 (95% CI 0·48–0·71) for MAOIs. Other drugs (amisulpride, amineptine and ritanserin) showed similar results. Patients treated on TCA were more likely to report adverse events, compared with placebo. There were no differences in response to active treatment when dysthymia was compared to either dysthymia plus major depression or briefer non-major depressive states.Conclusions. Drug treatment appears to be effective in the short-term management of dysthymic disorder. The choice of drug should take into account specific side-effects profile of each drug.

scholarly journals Breast Cancer Risk in Rheumatoid Arthritis: An Update Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Guo Tian ◽  
Jia-Ning Liang ◽  
Zhuo-Yun Wang ◽  
Dian Zhou
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Number Of Patients ◽  
The Impact

Background. The incidence of breast cancer in RA patients remains controversial. Thus we performed a meta-analysis to investigate the impact of RA on breast cancer.Methods. Published literature was available from PubMed, Embase, and Cochrane Library. Pooled standardized incidence rate (SIR) was computed by random-effect model analysis.Results. We identified 16 separate studies in the present study, in which the number of patients ranged from 458 to 84,475. We did not find the increased cancer risk in RA patients (SIR=0.86, 95%CI=0.72–1.02). However, subgroup analysis showed that breast cancer risk in RA patients was positively different in Caucasians (SIR=0.82, 95%CI=0.73–0.93) and non-Caucasians (SIR=1.21, 95%CI=1.19–1.23), respectively. In subgroup analysis by style, a reduced incidence was found in hospital-based case subjects (SIR=0.82, 95%CI=0.69–0.97). Similarly, subgroup analysis for adjusted factors indicated that in A3 (age and sex) and A4 (age, sex, and race/ethnicity) the risk was decreased (SIR=0.87, 95%CI=0.76–0.99;SIR=0.63, 95%CI=0.59–0.67).Conclusions. The meta-analysis revealed no increased breast cancer risk in RA patients. However, in the subgroup analysis, the risk of breast cancer is increased in non-Caucasians patients with RA while it decreased in Caucasian population, hospital-based case subjects, and A3 group. Such relationship may provide preference for risk of breast cancer in different population.

scholarly journals Burden of cervical lesion in Ethiopia: Systematic review and meta-analysis

2019 ◽  
Author(s):  
Ayele Semachew ◽  
Tadesse Dagget ◽  
Yeshiwork Beyene ◽  
Getnet Dessie ◽  
Aklilu Endalamaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cervical Lesion ◽  
Online Databases ◽  
Pooled Prevalence ◽  
Meta Regression Analysis ◽  
Study Participants

Abstract Though cervical cancer is largely preventable, it is still the second most common female cancer globally and the leading cause of cancer deaths among females in African. Though many efforts has been done to study the burden of the disease in Ethiopia, there are still fragmented primary studies reported cervical lesion. Hence, this systematic review and meta-analysis aimed in estimating the pooled prevalence of cervical cancer and its trend in Ethiopia. Methods: This systematic review and meta-analysis was conducted using available data. PubMed, Web of Science, SCOPUS, Science Direct, Google Scholar, African Index Medicus (AIM), African Journals Online databases and Ethiopian University research repositories were searched following the Preferred Items for Systematic review and Meta-analysis (PRISMA) guideline. STATA 15 statistical software was used to analyse the data. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) quality appraisal tool for meta-analysis. Heterogeneity between studies was assessed using Cochrane Q test and I2 test statistics based on the random effects model. A random effect model was computed to estimate the pooled prevalence of cervical lesion in Ethiopia. In addition, the trend of cervical lesion in the country was depicted. Result: Fifteen studies with a total of 25,348 participants were included in the analysis. The overall pooled prevalence of cervical lesion was 16.36 (95 CI: 10.97-21.75). The subgroup analysis by region showed the highest prevalence of cervical lesion at the Southern Nations and Nationalities Peoples Region (19.65%; 95% CI: 15.51 – 23.80). The trend of cervical lesion showed an increased pattern overtime from 1992 to 2018 in the meta-regression analysis. Conclusion: One among six of the study participants had cervical lesion. The trend also showed that there is still an increased cervical lesion in the country. Best practices in achieving high vaccination coverage shall be adapted from other successful countries. Key words: Cervical cancer, cervical lesion, systematic review, Ethiopia

scholarly journals Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

2019 ◽  
Author(s):  
Marta Berta Badi ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background: it is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Objective: The aim of this review was to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1,985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results: We identified 1,680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2=96.8%, p<000). Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

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