scholarly journals Incidence and Risk Factors for Postoperative Venous Thromboembolism in Patients with Endometrial Cancer: Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xing Zheng ◽  
XiaoYing Hou ◽  
Qing Wang ◽  
Ying Zhang
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cell Cancer ◽  
Uterine Cavity ◽  
Figo Stage ◽  
Massive Ascites

Abstract Background: Venous Thromboembolism (VTE) is a leading reason of morbidity and mortality in endometrial cancer patients. There is no meta-analysis available on this topic so far. In order to identify relevant risk factors contributing to VTE and form strategies to prevent VTE, we conducted the present study to quantitatively analyze the data from studies with the incidence and risk factors among cases with endometrial cancer.Methods: PubMed, Embase and CNKI were searched for papers containing the key words “thromboembolism” “endometrial cancer” and their variants. Studies selection, data extraction, quality assessment of eligible studies were performed independently by two reviewers. Meta-analyses were conducted to determine postoperative VTE incidence rate and risk factors in endometrial cancer. Sensitivity analysis was used to verify the robustness of the results in the present study.Results: 8 studies were included in this meta-analysis totally. The pooled incidence rate for postoperative VTE was 7% (95% CI, 0.04 –0.09).The presence of age>60 (OR, 2.26), tumor size in uterine cavity(＞60mm) (OR, 5.68), tumor extension (CT/MRI) (OR, 5.59), FIGO stage (OR, 2.92), massive ascites (OR, 3.78), clear cell cancer (OR, 4.78) and CA125(＞35U/ml) (OR, 5.05) increase the likelihood of having postoperative VTE remarkably. Conclusions: The present study revealed that VTE is a prevalent complication in postoperative patients with endometrial cancer. The patients with the following risk factor including female elderly, large size of tumor, advanced endometrial cancer，massive ascites , elevated CA125 and special histology should be altered VTE occurrence.

scholarly journals Survival in endometrial cancer in relation to minimally invasive surgery or open surgery – a Swedish Gynecologic Cancer Group (SweGCG) study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christer Borgfeldt ◽  
Erik Holmberg ◽  
Janusz Marcickiewicz ◽  
Karin Stålberg ◽  
Bengt Tholander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Surgical Approach ◽  
Open Surgery ◽  
Gynecologic Cancer ◽  
Multivariable Analysis ◽  
Figo Stage

Abstract Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

Abstract 47: Atrial Fibrillation is Associated With Increased Risk of Incident Venous Thromboembolism: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Pamela L Lutsey ◽  
Faye L Norby ◽  
Alvaro Alonso ◽  
Mary Cushman ◽  
Lin Y Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Case Reports ◽  
Time Dependent ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Shared Risk

Background: It is well-established that atrial fibrillation (AF) is associated with thrombus formation in the left atrium, which can lead to ischemic stroke. Case reports, autopsies, and transesophageal echo data have indicated that clot formation also occurs in the right atrium (i.e. right-side intracardiac thrombosis) of AF patients, which could lead to pulmonary embolism (PE). However, it is unclear whether this occurrence is common. Objective: Test the hypotheses that individuals with incident AF are at elevated risk of developing venous thromboembolism (VTE), and that the association will be stronger for those presenting with PE alone versus PE and deep vein thrombosis (DVT) or DVT alone. Methods: A total of 15,205 Atherosclerosis Risk in Communities (ARIC) study participants, aged 45-64 years, were followed from baseline (1987-1989) to 2011 for incidence of AF and VTE (median follow-up 19.8 years). Incident AF and VTE events were identified via active surveillance and defined by relevant hospital discharge ICD codes. VTE events were validated by medical record review. Multivariable-adjusted Cox proportional hazards regression models were used, with AF modeled as a time-dependent covariate. We also evaluated separately risk of PE without evidence of DVT, DVT without PE, and events presenting with both PE and DVT. Results: At baseline participants were on average 54 years old, 55% female and 26% black. In the absence of AF there were 678 VTE events, for an incidence rate of 2.6 per 1000 person-years. After an AF diagnosis there were 77 events, with an incidence rate of 7.1 per 1000 person-years. In multivariable-adjusted models, having AF (versus no AF) was associated with a greater risk of incident VTE; the HR (95% CI) was 2.10 (1.65-2.68) after adjustment for demographics, 1.82 (1.42-2.32) additionally accounting for numerous AF and VTE risk factors, and 1.97 (1.53-2.53) after further adjusting for time-dependent anticoagulant use. When we restricted to PE events without evidence of DVT there were 188 events in total, of which 19 occurred following a diagnosis of AF. The HR for AF (versus no AF) was 1.53 (0.92-2.56) in fully adjusted models. For DVT alone there were 384 events in total, of which 48 occurred after AF diagnosis; the HR for AF was 2.43 (1.77-3.33). Among the 116 events presenting with both DVT and PE, 10 occurred after AF diagnosis, and the HR for AF was 1.36 (0.67-2.75). Conclusions: Diagnosis with AF was associated with a nearly 2-fold increased risk of incident VTE. The association was not stronger when isolated to those with PE without DVT, suggesting that higher risk of VTE among AF patients may be due to either the coagulation abnormalities that accompany AF, or shared risk factors that were not fully accounted for in this analysis.

scholarly journals Different Finite Durations of Anticoagulation and Outcomes following Idiopathic Venous Thromboembolism: A Meta-Analysis

Thrombosis ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Aaron B. Holley ◽  
Christopher S. King ◽  
Jeffrey L. Jackson ◽  
Lisa K. Moores
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Data Extraction ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Secondary Prophylaxis ◽  
First Episode ◽  
Short Course ◽  
Recurrent Venous Thromboembolism ◽  
Prospective Trials

Introduction. Controversy remains over the optimal length of anticoagulation following idiopathic venous thromboembolism. We sought to determine if a longer, finite course of anticoagulation offered additional benefit over a short course in the initial treatment of the first episode of idiopathic venous thromboembolism. Data Extraction. Rates of deep venous thrombosis, pulmonary embolism, combined venous thromboembolism, major bleeding, and mortality were extracted from prospective trials enrolling patients with first time, idiopathic venous thromboembolism. Data was pooled using random effects meta-regression. Results. Ten trials, with a total of 3225 patients, met inclusion criteria. For each additional month of initial anticoagulation, once therapy was stopped, recurrent venous thromboembolism (0.03 (95% CI: −0.28 to 0.35); ), mortality (−0.10 (95% CI: −0.24 to 0.04); ), and major bleeding (−0.01 (95% CI: −0.05 to 0.02); ) rates measured in percent per patient years, did not significantly change. Conclusions: Patients with an initial idiopathic venous thromboembolism should be treated with 3 to 6 months of secondary prophylaxis with vitamin K antagonists. At that time, a decision between continuing with indefinite therapy can be made, but there is no benefit to a longer (but finite) course of therapy.

scholarly journals Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis

Parasite ◽  
2020 ◽  
Vol 27 ◽  
pp. 27
Author(s):  
Ehsan Ahmadpour ◽  
Hanie Safarpour ◽  
Lihua Xiao ◽  
Mehdi Zarean ◽  
Kareem Hatam-Nahavandi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Data Extraction ◽  
Meta Analysis ◽  
Diagnostic Methods ◽  
Detection Methods ◽  
Hiv Positive ◽  
Pooled Prevalence ◽  
Related Risk ◽  
Study Population ◽  
Staining Methods

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4 < 200 cells/mL. One hundred and sixty-one studies and 51,123 HIV-positive participants were included. The overall pooled prevalence of Cryptosporidium infection in HIV-positive patients was 11.2% (CI95%: 9.4%–13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%–11.8%) using staining methods, 13.5% (CI95%: 8.9%–19.8%) using molecular methods, and 26.3% (CI95%: 15.0%–42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4 < 200 cells/mL, and antiretroviral therapy risk factors with Cryptosporidiosis. Thus, Cryptosporidium is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

scholarly journals Environmental risk factors of leptospirosis in urban settings: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023359
Author(s):  
Mohd Hatta Abdul Mutalip ◽  
Mohd Amierul Fikri Mahmud ◽  
Noor Aliza Lodz ◽  
Norzawati Yoep ◽  
Eida Nurhadzira Muhammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Environmental Risk ◽  
Observational Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Environmental Risk Factors ◽  
Primary Data ◽  
Urban Settings ◽  
Susceptible Populations

IntroductionLeptospirosis is the most common zoonotic disease that causes morbidity and mortality worldwide. The disease can cause sporadic epidemics and recent epidemics have become more apparent in urban localities. There is lack of documented evidence on the specific risk factors of leptospirosis infection among the urbanites, thereby impeding initiatives for prevention in urban settings. We aim to systematically search published articles and synthesise evidence on the risk factors associated with leptospirosis infection among the susceptible populations in urban localities, particularly to identify the risk factors of non-recreational leptospirosis infection.Methods and analysisWe will conduct a systematic review of observational studies that investigated environmental risk factors of leptospirosis in urban localities. The search will be performed for any eligible articles from selected electronic databases from 1970 until May 2018. The study will include any studies that investigated risk factors of confirmed leptospirosis cases who acquired the infection in urban locality, particularly exposures from the non-recreational and non-water-related activities. Study selection and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Meta-Analysis of Observational Studies in Epidemiology guideline. All data will be extracted using a standardised data extraction form and quality of the studies will be assessed using the Newcastle-Ottawa Scale guideline. Descriptive and meta-analysis will be performed by calculating the standardised median ORs and risk ratios for types of the non-recreational risk factors stratified by social, living conditions and environmental exposures, types of reservoirs and transmissions and types of activities and employments associated with leptospirosis infection in urban locality.Ethics and disseminationNo primary data will be collected thus no formal ethical approval is required. The results will be disseminated though a peer-reviewed publication and conference presentation.PROSPERO registration numberCRD42018090820.

scholarly journals A proposal for a new classification of “unfavorable risk criteria” in patients with stage I endometrial cancer

2019 ◽  
Vol 29 (7) ◽  
pp. 1086-1093 ◽  
Author(s):  
Richard Li ◽  
Ashwin Shinde ◽  
Ernest Han ◽  
Stephen Lee ◽  
Sushil Beriwal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Lymphovascular Invasion ◽  
Figo Stage ◽  
Stage I ◽  
Adjuvant Radiation ◽  
New Classification ◽  
Stage Ib

BackgroundRandomized trials describe differing sets of high–intermediate risk criteria.ObjectiveTo use the National Cancer Database to compare the impact of radiation therapy in patients with stage I endometrial cancer meeting different criteria, and define a classification of “unfavorable risk.”MethodsPatients with stage I endometrial cancer between January 2010 and December 2014 were identified in the National Cancer Database and stratified into two cohorts: (1) patients meeting Gynecologic Oncology Group (GOG)-99 criteria only for high–intermediate risk, but not Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-1 criteria and (2) those meeting PORTEC-1 criteria only. High-risk stage I patients with both FIGO stage IB (under FIGO 2009 staging) and grade 3 disease were excluded. In each cohort, propensity score-matched survival analyses were performed. Based on these analyses, we propose a new classification of unfavorable risk. We then analyzed the association of adjuvant radiation with survival, stratified by this classification.ResultsWe identified 117,272 patients with stage I endometrial cancer. Of these, 11,207 patients met GOG-99 criteria only and 5,920 patients met PORTEC-1 criteria only. After propensity score matching, adjuvant radiation therapy improved survival (HR=0.73; 95% CI 0.60 to 0.89; p=0.002) in the GOG-99 only cohort. However, there was no benefit of adjuvant radiation (HR=0.89; 95% CI 0.69 to 1.14; p=0.355) in the PORTEC-1 only cohort. We, therefore, defined unfavorable risk stage I endometrial cancer as two or more of the following risk factors: lymphovascular invasion, age ≥70, grade 2–3 disease, and FIGO stage IB. Adjuvant radiation improved survival in stage I patients with adverse risk factors (HR=0.74; 95% CI 0.68 to 0.80; p<0.001), but not in other stage I patients (HR=1.02; 95% CI 0.91 to 1.15; p=0.710; p interaction <0.001).ConclusionOur study showed that adjuvant radiation was associated with an overall survival benefit in patients meeting GOG-99 criteria only; however, no survival benefit was seen in patients meeting PORTEC-1 criteria only. We propose a definition of unfavorable risk stage I endometrial cancer: ≥2 risk factors from among lymphovascular invasion, age ≥70, grade 2–3 disease, and FIGO stage IB disease.

Retrospective analysis of stage IC uterine cancer patients: A single center experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15573-e15573
Author(s):  
Nadire Kucukoztas ◽  
Selim Yalcin ◽  
Samed Rahatli ◽  
Ozlem Ozen ◽  
Nihan Haberal ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Uterine Cancer ◽  
Endometrial Adenocarcinoma ◽  
Cell Cancer ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Surgical Staging ◽  
Increased Risk

e15573 Background: Stage IC patients are at an increased risk of recurrence and overall worse prognosis compared with stage IA and IB patients. Adjuvant chemoherapy is utilized based on specific pathologic factors. The objective of this study is to evaluate treatment outcomes at a single institution in patients with 1988 FIGO stage IC endometrial adenocarcinoma. Methods: Records of the patients with FIGO stage IB (formerly IC) endometrial cancer were retrospectively evaluated. All patients were initially treated surgically with comprehensive staging lymphadenectomy. Results: A total of 85 patients were included. Patient and tumor characteristics are shown in the table. Median age of the patients was 60 (range 27-95). Fifty-nine patients had at least one co-morbid disease. Complete surgical staging including pelvic and paraaortic lymph node dissection was performed in all the patients. Sixteen patients (19%) received adjuvant chemotherapy, including 6 patients with serous cancer and one patient with small cell cancer. Paclitaxel/carboplatin was the preferred regimen in Median follow up was 30 months (range 10-61 months). Seven patients (8%) relapsed and 4 patients (5%) died on follow up. 5 year disease free survival was 89% and overall survival was 95%. One of the 16 patients (6.2%) who received chemotherapy and 6 of the 69 patients (8.7%) who did not receive relapsed/died on follow up. Survival analysis was not performed because of the low number of events in both groups. Conclusions: We found similar rates of recurrence and death with previous studies in stage IC endometrial cancer. Complete surgical staging is the mainstay of treatment. Marginally lower recurrence rate in chemotherapy treated patients delineate the need for prospective randomized data addressing the role of adjuvant systemic therapy in early-stage patients with endometrial adenocarcinoma. [Table: see text]

scholarly journals Identification of Risk Factors for Falls in Multiple Sclerosis: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 93 (4) ◽  
pp. 504-513 ◽  
Author(s):  
Hilary J. Gunn ◽  
Paul Newell ◽  
Bernhard Haas ◽  
Jonathan F. Marsden ◽  
Jennifer A. Freeman
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Fall Risk ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Factors Associated ◽  
Newcastle Ottawa Scale ◽  
Risk Factors For Falls

Background Falls are a significant issue in people with multiple sclerosis (MS), with research demonstrating fall rates of more than 50%. Purpose The purpose of this study was to evaluate the risk factors associated with falling in people with MS. Data Sources Mixed search methods were used, including computer-based and manual searches. Additionally, hand searches of reference lists and conference abstracts were performed. All literature published from the source's earliest date to January 2012 was included; only full-text English-language sources (or those where a translation was available) were included. Study Selection Eligibility criteria specified articles evaluating any aspect of fall risk in adults with a confirmed MS diagnosis, where the incidence of falling as determined by prospective or retrospective participant report was included. Data Extraction Data were extracted independently by 2 reviewers using a written protocol and standardized extraction documentation. Detailed assessment of each article was independently undertaken by both reviewers, including assessment of study quality using an adaptation of the Newcastle Ottawa Scale plus extraction of key data (participant characteristics, fall incidence, and outcomes). Data Synthesis The final review comprised 8 articles with a total of 1,929 participants; 1,037 (53.75%) were classified as fallers. Eighteen different risk factors were assessed within the included studies. Meta-analysis demonstrated an increase in fall risk associated with impairments of balance and cognition, progressive MS, and use of a mobility aid. Narrative review of the qualitative articles and those factors where meta-analysis was not possible also was undertaken. Limitations Variation in assessment, analysis, and reporting methods allowed meta-analysis for only 4 factors. Conclusion There is limited evidence of the factors associated with fall risk in people with MS. Further methodologically robust studies are needed.

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