scholarly journals Quantifying the benefit of chemotherapy and radiation in low-grade glioma: A systematic review and meta-analysis of numbers needed to treat.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2057-2057
Author(s):  
Timothy J Brown ◽  
Daniela Annenelie Bota ◽  
Elizabeth A. Maher ◽  
Dawit Gebremichael Aregawi ◽  
Linda M. Liau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Low Grade Glioma ◽  
Survival Advantage ◽  
Quality Data ◽  
Low Grade ◽  
High Quality ◽  
Quality Class ◽  
Numbers Needed To Treat

2057 Background: The optimal role of chemotherapy and radiation (RT) in adult low-grade glioma (LGG, WHO grade 1 & 2) is unclear. We conducted a systematic review and study-level meta-analysis of the literature on overall survival (OS) and progression free survival (PFS) in patients with LGG. Methods: Pubmed was queried with MeSH terms. All comparative studies of adults with newly diagnosed, supratentorial LGG were included. Comparisons of interest were OS and PFS at 2, 5, and 10 years in chemotherapy versus no chemotherapy and early RT versus delayed or no RT. Data were extracted from studies and synthesized with a random effects model. Quality of evidence was determined by American Academy of Neurology criteria and further analysis was performed, separating high quality (class I and II) from low quality (class III and IV) evidence. Numbers needed to treat (NNT) were determined from the risk difference. Results: 1531 articles were screened; 18 studies were included. Chemotherapy was not associated with a significant survival advantage compared to control. However, an analysis of high quality data revealed a survival advantage at 10 years associated with chemotherapy compared to control with NNT 5 (relative risk death chemo vs control 0.69 [0.56-0.86] p = 0.0006). Furthermore, NNT to prevent one progression with chemotherapy at 5 and 10 years was 6 and 3, respectively. Early RT was not associated with an OS advantage compared to control. However, early RT had progression benefit at all time points, with NNT of 10, 6, and 5 at 2, 5, and 10 years. Conclusions: Further study will be needed to confirm the optimal role of chemotherapy and RT. Caution must be used in interpretation as much of the literature consists of low-quality studies. [Table: see text]

P–639 The role of chronic inflammation in polycystic ovarian syndrome – a systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Amer ◽  
S Aboeldalyl ◽  
L Snell ◽  
H Shawky ◽  
E Seyam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Inflammation ◽  
Molecular Mechanisms ◽  
Polycystic Ovarian Syndrome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Low Grade ◽  
High Quality ◽  
Ovarian Syndrome

Abstract Study question Is polycystic ovarian syndrome (PCOS) associated with chronic inflammation as determined by elevated serum C-reactive protein (CRP) level independent of obesity? Summary answer: Circulating CRP is moderately elevated in women with PCOS (independent of obesity), which is indicative of low-grade chronic inflammation. What is known already Although current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. A systematic review and meta-analysis involving 31 studies was published on this topic in 2011 providing evidence for increased circulating CRP (96% higher than controls). However, since that review there have been over 100 published studies assessing CRP in PCOS women utilising more advanced CRP assays. Study design, size, duration This systematic review involved an extensive search of electronic databases for studies investigating CRP and other inflammatory makers in PCOS women from January 2000 to March 2020. Searched databases included PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library. Inclusion criteria were using Rotterdam criteria for PCOS diagnosis, measuring CRP with high-sensitivity assay, matching/adjusting participants for BMI, and including drug naïve participants who were free from conditions that could affect inflammatory markers. Participants/materials, setting, methods The review included all studies comparing circulating CRP between women with and without PCOS. Articles’ quality and risk of bias were assessed using modified Newcastle-Ottawa scale. CRP data were extracted from eligible studies and entered into RevMan software for calculation of standardized mean difference (SMD) and 95% Confidence Interval (CI). Sensitive analysis was performed for high-quality studies providing data for non-obese participants. Main results and the role of chance The systematic review included 95 eligible studies (n = 10,074), of which 68 (n = 7991) were included in a meta-analysis. Sixty-two of the 95 studies reported significantly higher circulating CRP in PCOS women (n = 5235) versus controls (n = 4839). The remaining studies showed no statistically significant differences between the two groups after adjusting for BMI. Pooled analysis of 68 studies revealed significantly higher circulating CRP in PCOS women (SMD 1.26, 95%CI, 1.01, 1.52; z = 9.60; p = 0.00001; I²=96%). Sensitivity meta-analysis for non-obese women in 37 high-quality studies showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.84, 95%CI, 1.40, 2.28; z = 8.19; p < 0.00001; I²=97%). Circulating TNF- α was measured in 13 studies, of which seven reported higher levels in PCOS women versus controls and six showed no difference. Circulating IL–6 was measured in 19 articles, of which eight reported significantly higher levels in PCOS women versus controls and 11 found no difference. Four studies (n = 512) reported increased white cell count in PCOS women (n = 323) compared with healthy controls (n = 189). Nine studies (n = 922) assessed circulating adiponectin, with seven showing significantly lower levels in PCOS women (n = 368) versus controls and one showing no difference. Meta-analysis of four of these studies (n = 355) revealed a SMD –1.48 (95% CI; –2.48,-.14). Limitations, reasons for caution High heterogeneity between studies and the small size of several studies are the main limitations. Heterogeneity is due to variation in laboratory methods used to measure CRP and variations between participants e.g. age, BMI and PCOS phenotypes. Sensitivity and sub-group analysis were performed to address this heterogeneity. Wider implications of the findings: Further research is required to understand the underlying molecular mechanisms and the pathophysiological role of chronic inflammation in PCOS. This could potentially identify targets for new treatments that could improve short- and long-term health problems associated with PCOS. Trial registration number N/A

scholarly journals Management of low-grade glioma: a systematic review and meta-analysis

2018 ◽  
Vol 6 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Timothy J Brown ◽  
Daniela A Bota ◽  
Martin J van Den Bent ◽  
Paul D Brown ◽  
Elizabeth Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
World Health ◽  
Subtotal Resection ◽  
Low Grade ◽  
Evidence Based ◽  
Free Survival ◽  
Low Grade Gliomas

Abstract Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

scholarly journals IDH1 mutation is associated with a higher preoperative seizure incidence in low-grade glioma: A systematic review and meta-analysis

Seizure ◽  
2018 ◽  
Vol 55 ◽  
pp. 76-82 ◽  
Author(s):  
Yucai Li ◽  
Xia Shan ◽  
Zhifeng Wu ◽  
Yinyan Wang ◽  
Miao Ling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Idh1 Mutation ◽  
Low Grade Glioma ◽  
Low Grade

Pseudoprogression after radiation therapies for low grade glioma in children and adults: A systematic review and meta-analysis

2020 ◽  
Vol 142 ◽  
pp. 36-42 ◽  
Author(s):  
Victor M. Lu ◽  
John P. Welby ◽  
Nadia N. Laack ◽  
Anita Mahajan ◽  
David J. Daniels
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Low Grade Glioma ◽  
Low Grade

Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 120 ◽  
pp. e762-e775 ◽  
Author(s):  
Kaiyun Yang ◽  
Siddharth Nath ◽  
Alex Koziarz ◽  
Jetan H. Badhiwala ◽  
Huphy Ghayur ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Low Grade ◽  
Total Resection

scholarly journals P10.03 Management of low-grade glioma: a systematic review and meta-analysis

2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii85-iii85
Author(s):  
T. J. Brown ◽  
D. Bota ◽  
E. Maher ◽  
D. Aregawi ◽  
L. M. Liau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Low Grade Glioma ◽  
Low Grade

scholarly journals Association of aggressive resection with survival and progression-free survival in adult low-grade glioma: A systematic review and meta-analysis with numbers needed to treat.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2025-2025 ◽  
Author(s):  
Timothy J Brown ◽  
Daniela Annenelie Bota ◽  
Elizabeth A. Maher ◽  
Dawit Gebremichael Aregawi ◽  
Linda M. Liau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
The Body ◽  
Subtotal Resection ◽  
Low Grade ◽  
Free Survival ◽  
Numbers Needed To Treat

2025 Background: Low-grade gliomas (LGG) account for 17-22% of all primary brain tumors. Optimal surgical management consists of optimum safe resection with the goal of complete resection. We performed a systematic review and meta-analysis to quantify the association of extent of resection with likelihood of survival, expressing our results in numbers needed to treat (NNT). Methods: A systematic review and study-level meta-analysis to determine the association of resection with overall survival and progression-free survival in newly diagnosed, supratentorial LGG in adults was performed by querying PubMed. Data were extracted to compare gross total resection (GTR) to subtotal resection (STR) and STR to biopsy (Bx) to determine relative risks (RR) of death and progression at 2, 5, and 10 years. Data were analyzed using a random effects model. NNT were calculated from significant comparisons and rounded up to the nearest whole number. Quality of evidence was determined by American Academy of Neurology criteria. Results: The systematic review resulted in 283 potential studies. Ultimately 29 studies were included in at least one comparison. There were no high quality (class I and II) or prospective studies discovered in the review. Comparing GTR to STR, RR with 95% confidence intervals (CI) of death at 2, 5, and 10 years, and NNT to avoid one death at 2, 5, and 10 years (GTR vs. STR) were 0.29 [0.17-0.52, p < 0.0001, NNT 17], 0.39 [0.29-0.51, p < 0.00001, NNT 6], and 0.50 [0.35-0.70, p < 0.0001 NNT 4]. RR and NNT for progression (GTR vs. STR) at 2, 5, and 10 years were 0.37 [0.24-0.57, p < 0.0001 NNT 7], 0.50 [0.39-0.64, p < 0.0001 NNT 4], and 0.67 [0.53-0.84, p = 0.0005 NNT 4]. Comparing STR to Bx, RR of death at 2, 5, and 10 years were 0.55 [0.34-0.88, p = 0.01 NNT 10], 0.9 [0.61-1.34], and 0.95 [0.73-1.23]. Conclusions: Increasing resection thresholds appear to be associated with improved overall and progression free survival, but the body of literature consists of low quality studies. Prospective studies are required to explore whether extent of resection matters or whether resectable tumors share a favorable biology associated with better outcome.

scholarly journals Prognosis of Upfront Surgery for Pancreatic Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

2022 ◽  
Vol 11 ◽  
Author(s):  
Nicolò Pecorelli ◽  
Alice W. Licinio ◽  
Giovanni Guarneri ◽  
Francesca Aleotti ◽  
Stefano Crippa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Risk Of Bias ◽  
Quality Data ◽  
High Quality ◽  
Borderline Resectable ◽  
Resectable Disease ◽  
Weighted Median

BackgroundThe rate of patients with pancreatic ductal adenocarcinoma (PDAC) receiving neoadjuvant chemotherapy is increasing, but upfront resection is still offered to most patients with resectable or borderline resectable disease. Encouraging data reported in adjuvant chemotherapy trials prompts surgeons towards upfront surgery, but such trials are subject to a significant selection bias. This systematic review aims to summarize available high-quality evidence regarding survival of patients treated with upfront surgery for PDAC.MethodsPubmed, Cochrane, and Web of Science Databases were interrogated for prospective studies published between 2000 and 2021 that included at least a cohort of patients treated with upfront surgery for resectable or borderline resectable PDAC. The Cochrane Collaboration’s risk-of-bias tool for randomized trials (RoB-2) was used to assess risk of bias in all randomized studies. Patient weighted median overall survival (OS) and disease-free survival (DFS) were calculated.ResultsOverall, 8,341 abstracts were screened, 17 reports were reviewed in full text, and finally 5 articles and 1 conference abstract underwent data extraction. Included studies were published between 2014 and 2021. All studies were RCTs comparing different neoadjuvant treatment strategies to upfront surgery. Three studies included only resectable PDAC patients, two studies recruited patients with resectable and borderline resectable disease, and one study selected only borderline resectable patients. A total of 439 patients were included in the upfront resection cohorts of the 6 studies, ranging between 20 to 180 patients per study. The weighted median OS after upfront surgery was 18.8 (95% CI 12.4 – 20.6) months. Median DFS was 9 (95% CI 1.6 – 12.5) months. Resection rate was 74.5% (range 65-90%). Adjuvant treatment was initiated in 68% (range 43-77%) of resected patients.ConclusionsHigh-quality data for PDAC patients undergoing upfront surgery is scarce. Meta-analysis from the included studies showed a significantly shorter OS and DFS compared to recently published studies focusing on adjuvant combination chemotherapy, suggesting that the latter may overestimate survival due to the exclusion of most patients scheduled for upfront surgery.

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