scholarly journals Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients With Resectable Rectal Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Xinlong Li ◽  
Xiangyuan Li ◽  
Rongrong Fu ◽  
Derry Minyao Ng ◽  
Tong Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Term Survival ◽  
Resectable Rectal Cancer ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background: The impact of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer is controversial. This study aimed to explore the effect of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to find relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: Compared with upfront surgery, our meta-analysis showed that 5-year OS (HR: 0.84, 95% Cl: 0.78-0.91) and DFS (HR: 0.91, 95% Cl: 0.87-0.95) were prolonged for patients with resectable rectal cancer after receiving neoadjuvant therapy. The results of subgroup analysis suggested that both neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) could improve the 5-year OS and DFS. The 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer increased significantly and the improvement of 5-year OS and DFS could also be observed in mid/low rectal cancer.Conclusion: Neoadjuvant therapy could improve the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ. For the treatment, neoadjuvant SCRT and neoadjuvant CRT were recommended.

scholarly journals Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: a Meta-Analysis

2021 ◽  
Author(s):  
Xinlong Li ◽  
Xiangyuan Li ◽  
Rongrong Fu ◽  
Derry Minyao Ng ◽  
Tong Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Term Survival ◽  
Resectable Rectal Cancer ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background: The impact of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer is controversial. This study aimed to explore the effect of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to find relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: Compared with upfront surgery, our meta-analysis showed that 5-year OS (HR: 0.84, 95% Cl: 0.78-0.91) and DFS (HR: 0.91, 95% Cl: 0.87-0.95) were prolonged for patients with resectable rectal cancer after receiving neoadjuvant therapy. The results of subgroup analysis suggested that both neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) could improve the 5-year OS and DFS. The 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer increased significantly and the improvement of 5-year OS and DFS could also be observed in mid/low rectal cancer.Conclusion: Neoadjuvant therapy could improve the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ. For the treatment, neoadjuvant SCRT and neoadjuvant CRT were recommended.

Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: A Meta-Analysis

2021 ◽  
Vol 21 ◽  
Author(s):  
Xinlong Li ◽  
Xiangyuan Li ◽  
Rongrong Fu ◽  
Derry Ng ◽  
Tong Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Term Survival ◽  
Long Term Survival ◽  
Resectable Rectal Cancer ◽  
Long Term Prognosis

Background: The impact of neoadjuvant therapy on long-term prognosis of patients with resectable rectal cancer is currently unknown. Objective: This study aimed to explore the long-term prognosis of patients with resectable rectal cancer following treatment with neoadjuvant therapy. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to identify relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: The meta-analysis revealed that 5-year OS (HR: 0.88, 95% Cl: 0.83-0.93) and DFS (HR: 0.95, 95% Cl: 0.91-0.98) were higher in patients with resectable rectal cancer after receiving neoadjuvant therapy than those treated with upfront surgery. Subgroup analysis demonstrated that the long-term survival of patients in Asia and Europe could benefit from neoadjuvant therapy. The neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) improved the 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer and mid/low rectal cancer. Further research found that patients with stage Ⅱ only had an increase in OS, while patients with stage Ⅲ have improved 5-year OS and DFS. Conclusion: Neoadjuvant therapy improved the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ (especially stage Ⅲ). Additionally, patients in Asia and Europe seemed to be more likely to benefit from neoadjuvant therapy. For the treatment, we recommend neoadjuvant SCRT and neoadjuvant CRT for resectable rectal cancer.

scholarly journals Effect of volatile and intravenous anesthesia on long-term survival of cancer surgery patients: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Li Gong ◽  
Chao Dong ◽  
Qian Cai ◽  
Wen Ouyang
Keyword(s):  
Cancer Patients ◽  
Meta Analysis ◽  
Cancer Surgery ◽  
Anesthetic Techniques ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background The impact of volatile anesthesia (INHA) and total intravenous anaesthesia (TIVA) on the long-term survival of patients after oncology surgery is a subject of controversy. The purpose of this study was to make overall evaluation of the association between these two anesthetic techniques and long-term prognosis of oncology patients after surgery. Methods Databases were searched according to the PRISMA guidelines up to September 30, 2018. Hazard ratios (HRs) with its 95% confidence intervals (CIs) were calculated after multivariable analyses and propensity score (PS) adjustments. Eight retrospective cohort articles reporting data on overall survival (OS) and recurrence-free survival (RFS) were included. An inverse variance random effects meta-analysis was conducted. The Newcastle Scale was used to assess methodological quality and bias. Results In total, about 18922 cancer patients observed were included in the meta-analysis, of which 10433 cases were available for analysis in INHA and 8489 in TIVA group. Compared to TIVA, INHA showed a shorter OS (HR =1.27, 95% CI 1.069 to 1.516, p=0.007), with a medium heterogeneity (Q-test p=0.003, I-squared=67.6%). However, no significant differences were identified between INHA and TIVA group (HR =1.10, 95% CI 0.729 to 1.659, p=0.651) concerning RFS albeit from a limited data pool. When a subgroup analysis was performed by race, the association was more likely to be observed in the Asian studies (HR=1.46, 95%CI 1.19–1.8, p =0.00), with a much lower heterogeneity (Q-test p=0.148, I-squared=44%). When comparison was done only in breast cancer patients, no significant differences were found for OS (HR=1.625, 95%CI 0.273-9.67, p=0.594) between INHA and TIVA. Conclusion TIVA for cancer surgery might be associated with better OS compared to INHA. The effect of INHA and TIVA on OS and RFS in the perioperative setting remains uncertain, cancer-specific, and has low-level evidence at present. Randomized controlled trials are required in future work. Registry number The review protocol was registered with PROSPERO (Registration NO.CRD42018109341).

scholarly journals The Oncologic Efficacy and Long-term Survival Outcomes of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Systemic Review and Meta-Analysis

2021 ◽  
Author(s):  
Gan Bin Li ◽  
Yu Tao ◽  
Zhen Jun Wang ◽  
Zhai Wei Zhai ◽  
Jia-Gang Han
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Total Neoadjuvant Therapy

Abstract Purpose To evaluate the pooled oncologic efficacy of total neoadjuvant therapy for locally advanced rectal cancer patients using meta-analysis method.Method To evaluate the pooled effects of total neoadjuvant therapy in terms of exact oncologic efficacy and long-term survival outcomes, a systemic literature search of PubMed, Embase, China Biology Medicine and WanFang Database was performed.Results A total of 15 studies including 4091 patients were finally identified. The pooled analysis revealed that total neoadjuvant therapy significantly increased the rates of T-downstaging (OR=2.16, 95% CI:1.63~2.87, P<0.00001), pathologic complete response (OR=1.90, 95% CI:1.60~2.27, P<0.00001) and R0 resection (OR=1.44, 95% CI: 1.07~1.93, P=0.01) with a comparable safety profile. Most importantly, patients received total neoadjuvant therapy had a superior overall survival rate compared to standard neoadjuvant chemoradiotherapy (HR=0.74, 95% CI: 0.62~0.89, P=0.001).Conclusion Patients with locally advanced rectal cancer can be managed with total neoadjuvant therapy with a superior short-term oncologic efficacy and long-term survival benefits.

scholarly journals Effect of Volatile and Intravenous Anesthesia on Long-Term Survival of Cancer Surgery Patients: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Li Gong ◽  
Chao Dong ◽  
Qian Cai ◽  
Wen Ouyang
Keyword(s):  
Cancer Patients ◽  
Meta Analysis ◽  
Cancer Surgery ◽  
Anesthetic Techniques ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background The impact of volatile anesthesia (INHA) and total intravenous anaesthesia (TIVA) on the long-term survival of patients after oncology surgery is a subject of controversy. The purpose of this study was to make overall evaluation of the association between these two anesthetic techniques and long-term prognosis of oncology patients after surgery. Methods Databases were searched according to the PRISMA guidelines up to September 30, 2018. Hazard ratios (HRs) with its 95% confidence intervals (CIs) were calculated after multivariable analyses and propensity score (PS) adjustments. Eight retrospective cohort articles reporting data on overall survival (OS) and recurrence-free survival (RFS) were included. An inverse variance random effects meta-analysis was conducted. The Newcastle Scale was used to assess methodological quality and bias. Results In total, about 18922 cancer patients observed were included in the meta-analysis, of which 10433 cases were available for analysis in INHA and 8489 in TIVA group. Compared to TIVA, INHA showed a shorter OS (HR =1.27, 95% CI 1.069 to 1.516, p=0.007), with a medium heterogeneity (Q-test p=0.003, I-squared=67.6%). However, no significant differences were identified between INHA and TIVA group (HR =1.10, 95% CI 0.729 to 1.659, p=0.651) concerning RFS albeit from a limited data pool. When a subgroup analysis was performed by race, the association was more likely to be observed in the Asian studies (HR=1.46, 95%CI 1.19–1.8, p =0.00), with a much lower heterogeneity (Q-test p=0.148, I-squared=44%). When comparison was done only in breast cancer patients, no significant differences were found for OS (HR=1.625, 95%CI 0.273-9.67, p=0.594) between INHA and TIVA. Conclusion TIVA for cancer surgery might be associated with better OS compared to INHA. The effect of INHA and TIVA on OS and RFS in the perioperative setting remains uncertain, cancer-specific, and has low-level evidence at present. Randomized controlled trials are required in future work.

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 Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors

2021 ◽  
Vol 10 (5) ◽  
pp. 1141
Author(s):  
Gianpaolo Marte ◽  
Andrea Tufo ◽  
Francesca Steccanella ◽  
Ester Marra ◽  
Piera Federico ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Liver Metastases ◽  
Meta Analysis ◽  
Multidisciplinary Treatment ◽  
Review Of The Literature ◽  
Term Survival ◽  
The Impact

Background: In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. Methods: The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. Results: We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1–2 and pN0–1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. Conclusion: In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.

Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis

2020 ◽  
pp. 030089162097586
Author(s):  
Pratik Tripathi ◽  
Zhen Li ◽  
Yaqi Shen ◽  
Xuemei Hu ◽  
Daoyu Hu
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Vascular Invasion ◽  
Literature Search ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Cochrane Library ◽  
Nodal Disease ◽  
The Impact

Background: The impact of magnetic resonance imaging–detected extramural vascular invasion (mrEMVI) in distant metastasis is well known but its correlation with prevalence of lymph node metastasis is less studied. The aim of this systematic review and meta-analysis was to assess the prevalence of nodal disease in mrEMVI–positive and negative cases in rectal cancer. Methods: Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in PubMed, Web of Science, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2019. Results: Our literature search generated 10 studies (863 and 1212 mrEMVI–positive and negative patients, respectively). The two groups (mrEMVI–positive and negative) were significantly different in terms of nodal disease status (odds ratio [OR] 3.15; 95% confidence interval [CI] 2.12–4.67; p < 0.001). The prevalence of nodal disease was 75.90% vs 52.56% in the positive mrEMVI vs negative mrEMVI group, respectively ( p < 0.001). The prevalence of positive lymph node in positive mrEMVI patients treated with neoadjuvant/adjuvant chemoradiotherapy (nCRT/CRT) (OR 2.47; 95% CI 1.65–3.69; p < 0.001) was less compared with the patients who underwent surgery alone (OR 6.25; 95% CI 3.74–10.44; p < 0.001). Conclusion: The probability of positive lymph nodes in cases of positive mrEMVI is distinctly greater compared with negative cases in rectal cancer. Positive mrEMVI indicates risk of nodal disease prevalence increased by threefold in rectal cancer.

scholarly journals Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair

2021 ◽  
Author(s):  
Martin Geyer ◽  
Karsten Keller ◽  
Kevin Bachmann ◽  
Sonja Born ◽  
Alexander R. Tamm ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Survival Data ◽  
Common Finding ◽  
Prognostic Impact ◽  
Term Survival ◽  
Long Term Prognosis ◽  
The Impact ◽  
Symptomatic Benefit

Abstract Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract

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