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Cardiovascular and Interventional... Dec 2021Performing a systematic review and meta-analysis to assess the evidence of intra-arterial therapies in liver metastatic breast cancer (LMBC) patients. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Performing a systematic review and meta-analysis to assess the evidence of intra-arterial therapies in liver metastatic breast cancer (LMBC) patients.
METHODS
A systemic literature search was performed in PubMed, EMBASE, SCOPUS for studies regarding intra-arterial therapies in LMBC patients. Full text studies of LMBC patients (n ≥ 10) published between January 2010 and December 2020 were included when at least one outcome among response rate, adverse events or survival was available. Response rates were pooled using generalized linear mixed models. A weighted estimate of the population median overall survival (OS) was obtained under the assumption of exponentially distributed survival times.
RESULTS
A total of 26 studies (1266 patients) were included. Eleven articles reported on transarterial radioembolization (TARE), ten on transarterial chemoembolization (TACE) and four on chemo-infusion. One retrospective study compared TARE and TACE. Pooled response rates were 49% for TARE (95%CI 32-67%), 34% for TACE (95%CI 22-50%) and 19% for chemo-infusion (95%CI 14-25%). Pooled median survival was 9.2 months (range 6.1-35.4 months) for TARE, 17.8 months (range 4.6-47.0) for TACE and 7.9 months (range 7.0-14.2) for chemo-infusion. No comparison for OS was possible due to missing survival rates at specific time points (1 and 2 year OS) and the large heterogeneity.
CONCLUSION
Although results have to be interpreted with caution due to the large heterogeneity, the superior response rate of TARE and TACE compared to chemo-infusion suggests first choice of TARE or TACE in chemorefractory LMBC patients. Chemo-infusion could be considered in LMBC patients not suitable for TARE or TACE.
LEVEL OF EVIDENCE
3a.
Topics: Breast Neoplasms; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Female; Humans; Liver Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 34322751
DOI: 10.1007/s00270-021-02906-1 -
PloS One 2015To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically... (Review)
Review
AIM
To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically review the related literature.
METHODS
Since January 2013, patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow hepatic resection were prospectively assessed for the ALPPS procedure. A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central.
RESULTS
Until July 2014 ALPPS was completed in 9 patients whose mean age was 60 ± 8 years. Indications for surgical resection were metastases from colorectal cancer in 3 cases, perihilar cholangiocarcinoma in 3 cases, intrahepatic cholangiocarcinoma in 2 cases and hepatocellular carcinoma without chronic liver disease in 1 case. The calculated FLR volume was 289 ± 122 mL (21.1 ± 5.5%) before ALPPS-1 and 528 ± 121 mL (32.2 ± 5.7%) before ALLPS-2 (p < 0.001). The increase in FLR between the two procedures was 96 ± 47% (range: 24-160%, p < 0.001). Additional interventions were performed in 4 cases: 3 patients underwent Roux-en-Y hepaticojejunostomy, and one case underwent wedge resection of a residual tumor in the FLR. The average time between the first and second step of the procedure was 10.8 ± 2.9 days. The average hospital stay was 24.1 ± 13.3 days. There was 1 postoperative death due to hepatic failure in the oldest patient of this series who had a perihilar cholangiocarcinoma and concomitant liver fibrosis; 11 complications occurred in 6 patients, 4 of whom had grade III or above disease. After a mean follow-up of 17.1 ± 8.5 months, the overall survival was 89% at 3-6 and 12 months. The recurrence-free survival was 100%, 87.5% and 75% at 3-6-12 months respectively. The literature search yielded 148 articles, of which 22 articles published between 2012 and 2015 were included in this systematic review.
CONCLUSION
The ALPPS technique effectively increased the resectability of otherwise inoperable liver tumors. The postoperative morbidity in our series was high in accordance with the data from the systematic review. Age, liver fibrosis and presence of biliary stenting were predisposing factors for postoperative morbidity and mortality.
Topics: Aged; Disease-Free Survival; Female; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Organ Size; Treatment Outcome
PubMed: 26700646
DOI: 10.1371/journal.pone.0144019 -
Liver Transplantation : Official... Sep 2015Downstaging can facilitate liver transplantation (LT) for patients outside of Milan criteria with hepatocellular carcinoma (HCC); however, the optimal protocol and... (Meta-Analysis)
Meta-Analysis Review
Downstaging can facilitate liver transplantation (LT) for patients outside of Milan criteria with hepatocellular carcinoma (HCC); however, the optimal protocol and downstaging outcomes are poorly defined. We aimed to characterize rates of successful downstaging to within Milan criteria and post-LT recurrence and survival among patients who underwent downstaging. We performed a systematic literature review using the MEDLINE and Embase databases from January 1996 through March 2015 and a search of national meeting abstracts from 2010 to 2014. Rates of downstaging success (defined as a decrease of tumor burden to within Milan) and post-LT recurrence with 95% confidence intervals (CIs) were calculated. Prespecified subgroup analyses were conducted by treatment modality, study design, and patient characteristics. Thirteen studies (n = 950 patients) evaluating downstaging success had a pooled success rate of 0.48 (95% CI, 0.39-0.58%). In subgroup analyses, there was no significant difference comparing transarterial chemoembolization (TACE) versus transarterial radioembolization (TARE; P = 0.51), but there were higher success rates in prospective versus retrospective studies (0.68 versus 0.44; P < 0.001). The 12 studies (n = 320 patients) evaluating post-LT HCC recurrence had a pooled recurrence rate of 0.16 (95% CI, 0.11-0.23). There was no significant difference in recurrence rates between TACE and TARE (P = 0.33). Post-LT survival could not be aggregated because of heterogeneity in survival data reporting. Current data have heterogeneity in baseline tumor burden, waiting time, downstaging protocols, and treatment response assessments. There are also notable limitations including inconsistent reporting of inclusion criteria, downstaging protocols, and outcome assessment criteria. In conclusion, the success rate of downstaging HCC to within Milan criteria exceeds 40%; however, posttransplant HCC recurrence rates are high at 16%. Downstaging protocols for HCC should be systematically studied and optimized to minimize the risk of post-LT HCC recurrence.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver Transplantation; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25981135
DOI: 10.1002/lt.24169 -
Radiotherapy and Oncology : Journal of... Apr 2020Radiofrequency ablation (RFA) is a standard ablative modality for small liver malignancies. Stereotactic body radiotherapy (SBRT) has emerged although yet suffers a lack... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Radiofrequency ablation (RFA) is a standard ablative modality for small liver malignancies. Stereotactic body radiotherapy (SBRT) has emerged although yet suffers a lack of high-level evidence. We performed meta-analyses and a systematic review to integrate the literature and help in clinical decision-making.
METHODS
Systemic searches were performed of the PubMed, Medline, and EMBASE databases to identify controlled studies comparing RFA and SBRT.
RESULTS
Eleven studies involving 2238 patients were included. Among them, eight studies were for treating early hepatocellular carcinomas (HCCs) and three for liver metastases. Including HCCs and liver metastases studies, the pooled two-year local control (LC) rate was higher in the SBRT arm (83.8%, 95% confidence interval [CI]: 77.6-88.4) than that in the RFA arm (71.8%, 95% CI: 61.5-80.2) (p = 0.024). Among studies on liver metastases, the pooled two-year LC rate was higher in the SBRT arm (83.6% vs. 60.0%, p < 0.001). No significant difference was found between arms in HCC studies (SBRT vs. RFA: 84.5 vs. 79.5% p = 0.431). Pooled analysis of overall survival (OS) in HCC studies showed an odds ratio of 1.43 (95% CI: 1.05-1.95, p = 0.023), favoring RFA. Among the two liver metastases studies with comparative survival data, no significant difference was observed.
CONCLUSION
LC was equivalent between RFA and SBRT for HCC and better for SBRT for the treatment of liver metastases. RFA was associated with better OS for HCC, but discrepancy between LC and OS requires further investigation, as they are local modalities having comparable efficacy.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Radiofrequency Ablation; Radiosurgery
PubMed: 31923711
DOI: 10.1016/j.radonc.2019.12.004 -
Cancer Treatment Reviews Sep 2018Despite the amelioration of systemic therapy, overall survival (OS) of metastatic gastric cancer (GC) patients remains poor. Liver is a common metastatic site and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Despite the amelioration of systemic therapy, overall survival (OS) of metastatic gastric cancer (GC) patients remains poor. Liver is a common metastatic site and retrospective series suggest a potential OS benefit from hepatectomy, with interesting 5-year (5 y) and 10-year (10 y) OS rates in selected patients. We aim to evaluate the impact of liver resection and related prognostic factors on long-term outcome in this setting.
METHODS
We searched Pubmed, EMBASE, and Abstracts/posters from international meetings since 1990. Data were extracted from publish papers. Random effects models meta-analyses and meta-regression models were built to assess 5yOS and the impact of different prognostic factor. Heterogeneity was assessed using between study variance, I and Cochran's Q. Funnel plot were used to assess small study bias.
RESULTS
Thirty-three observational studies (for a total of 1304 patients) were included. Our analysis demonstrates a 5yOS rate of 22% (95%CI: 18-26%) and 10yOS rate of 11% (95%CI: 7-18%) among patients undergoing radical hepatectomy. A favorable effect on OS was shown by several factors linked to primary cancer (lower T and N stage, no lympho-vascular or serosal invasion) and burden of hepatic disease (≤3 metastases, unilobar involvement, greatest lesion < 5 cm, negative resection margins). Moreover, lower CEA and CA19.9 levels and post-resection chemotherapy were associated with improved OS.
CONCLUSIONS
Surgical resection of liver metastases from GC seems associated with a significant chance of 5yOS and 10yOS and compares favourably with results of medical treatment alone. Prospective evaluation of this approach and validation of adequate selection criteria are needed.
Topics: Biomarkers; Hepatectomy; Humans; Liver Neoplasms; Prognosis; Stomach Neoplasms; Survival Rate
PubMed: 29860024
DOI: 10.1016/j.ctrv.2018.05.010 -
Journal of Cellular Physiology Feb 2016Because early-stage hepatocellular carcinoma (HCC) is difficult to diagnose using the existing techniques, identifying better biomarkers would likely improve the... (Meta-Analysis)
Meta-Analysis Review
Because early-stage hepatocellular carcinoma (HCC) is difficult to diagnose using the existing techniques, identifying better biomarkers would likely improve the patients' prognoses. We performed a systematic review and meta-analysis of published studies to appraise the utility of microRNAs (miRNAs) for the early diagnosis of HCC. Pertinent literature was collected from the Medline, Embase, and Chinese National Knowledge Infrastructure databases. We analyzed 50 studies that included 3423 cases of HCC, 2403 chronic hepatic disease (CH) patients, and 1887 healthy controls in 16 articles. Summary receiver operating characteristic analyses of all miRNAs showed an area under the curve (AUC) of 0.82, with 75.8% sensitivity and 75.0% specificity in discriminating patients with HCC from healthy controls. miR-21 and miR-122 individually distinguished patients with HCC from healthy controls, with an AUC of 0.88 for miR-21 and 0.77 for miR-122. The sensitivity and specificity for miR-21 were 86.6% and 79.5%, respectively, those for miR-122 were 68.0% and 73.3%. We conclude that circulating miRNAs, particularly miR-21, and miR-122, are promising biomarkers for the early diagnosis of HCC.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Case-Control Studies; Early Diagnosis; Humans; Liver Neoplasms; MicroRNAs; Predictive Value of Tests; RNA, Neoplasm
PubMed: 26291451
DOI: 10.1002/jcp.25135 -
Annals of the Royal College of Surgeons... Apr 2023The current gold standard treatment for breast cancer liver metastases (BCLM) is systemic chemotherapy and/or hormonal therapy. Nonetheless, greater consideration has... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The current gold standard treatment for breast cancer liver metastases (BCLM) is systemic chemotherapy and/or hormonal therapy. Nonetheless, greater consideration has been given to local therapeutic strategies in recent years. We sought to compare survival outcomes for available systemic and local treatments for BCLM, specifically surgical resection and radiofrequency ablation.
METHODS
A review of the PubMed (MEDLINE), Embase and Cochrane Library databases was conducted. Data from included studies were extracted and subjected to time-to-event data synthesis, algorithmically reconstructing individual patient-level data from published Kaplan-Meier survival curves.
FINDINGS
A total of 54 studies were included, comprising data for 5,430 patients (surgery, =2,063; ablation, =305; chemotherapy, =3,062). Analysis of the reconstructed data demonstrated survival rates at 1, 3 and 5 years of 90%, 65.9% and 53%, respectively, for the surgical group, 83%, 49% and 35% for the ablation group and 53%, 24% and 14% for the chemotherapy group (<0.0001).
CONCLUSION
Local therapeutic interventions such as liver resection and radiofrequency ablation are effective treatments for BCLM, particularly in patients with metastatic disease localised to the liver. Although the data from this review support surgical resection for BCLM, further prospective studies for managing oligometastatic breast cancer disease are required.
Topics: Humans; Female; Breast Neoplasms; Prospective Studies; Liver Neoplasms; Treatment Outcome; Hepatectomy; Melanoma, Cutaneous Malignant
PubMed: 35175853
DOI: 10.1308/rcsann.2021.0308 -
Critical Reviews in Oncology/hematology Mar 2018Primary hepatic lymphoma (PHL) is defined as a lympho-proliferative disorder limited to the liver without any involvement of the spleen, lymph nodes, bone marrow or... (Review)
Review
Primary hepatic lymphoma (PHL) is defined as a lympho-proliferative disorder limited to the liver without any involvement of the spleen, lymph nodes, bone marrow or blood. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type counting more than 60-80% of all PHL. Usually, it occurs in middle-aged men with aspecific symptoms and diagnosis is confirmed by histopathology. In order to expand current knowledge and to investigate an optimal therapeutic strategy, a systematic review of literature was conducted in February 2016. A total of 274 articles were retrieved, and after exclusion, 55 were retained, reporting 147 cases of PHL. Patients were mainly men (64.9%) with a median age at diagnosis of 57 years (range: 17-92) and right hepatic lobe involvement (69.6%). Among the 147 patients, 9% received no therapy while 77% underwent treatment including chemotherapy, surgery and radiotherapy in 64%, 26% and 1% of cases, respectively. Mean follow-up was 22.6 months (range: 0.2-360). Overall mortality was 29.2% with a 90-day mortality of 26%. Risk factors for increased mortality include; bilobar lesions (p = 0.001), right lobe localisation (p = 0.003) and non-surgical approach or the absence of any treatment (p = 0.001). A trend towards favourable outcomes for young patients (mean = 50.4 years) with a large liver lesion was achieved by surgical management of PHL but this did not achieve statistical significance. Statistical analysis indicates that in cases of resectable disease, an aggressive surgical approach in selected patients leads to increase long-term survival. Thus, two hypotheses should be assessed in further randomized studies: 1°) resectable PHL is a less severe form or 2°) hepatectomy is an effective treatment for PHL.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Hepatectomy; Humans; Liver Neoplasms; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome; Young Adult
PubMed: 29482772
DOI: 10.1016/j.critrevonc.2018.01.004 -
Future Oncology (London, England) 2015Liver metastases from breast cancer (BCLM) confer poor survival. Liver resection in BCLM patients has been increasingly employed. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Liver metastases from breast cancer (BCLM) confer poor survival. Liver resection in BCLM patients has been increasingly employed.
AIM
We undertook a systematic review to evaluate the role of hepatic resection in patients with breast cancer metastatic to the liver.
MATERIALS & METHODS
In total, 36 studies were overviewed. Patient populations, characteristics, morbidity, mortality and survival were documented.
RESULTS
Median overall survival was 41 months. Major morbidity was rare while 30-day postoperative mortality was near nil.
CONCLUSION
Liver surgery for BCLM can be performed with low mortality, acceptable morbidity and promising survival benefit in carefully selected patients.
Topics: Breast Neoplasms; Female; Humans; Liver Neoplasms; Morbidity; Mortality; Retreatment; Treatment Outcome
PubMed: 25963429
DOI: 10.2217/fon.15.43 -
Frontiers in Public Health 2022The association between environmental and socioeconomic risk factors and the occurrence of hepatocellular carcinoma (HCC) are still inconclusive. A meta-analysis was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between environmental and socioeconomic risk factors and the occurrence of hepatocellular carcinoma (HCC) are still inconclusive. A meta-analysis was conducted to address this issue.
METHODS
We systematically searched the databases including PubMed, Web of Science, and Google Scholar and collected the related risk factors of HCC before March 6, 2020. Statistical analysis was performed on the odds ratio (OR) value and 95% CI of the correlation between environmental and socioeconomic factors and HCC. Begg's rank correlation test, Egger's linear regression test, and the funnel plot were employed for identification of the publication bias.
RESULTS
Out of 42 studies, a total of 57,892 participants were included. Environmental and socioeconomic risk factors including ever educated (illiteracy); race (Black, Hispanic, and Asian); medium and low incomes; occupations (farmer and labor); passive smoking; place of residence (rural); blood aflatoxin B1 (AFB1) adduct level; exposure of pesticide, etc., were statistically increased with the occurrence of HCC ( < 0.05) and OR values and 95% CIs were 1.37 (1.00, 1.89), 2.42 (1.10-5.31), 1.90 (0.87-4.17), 5.36 (0.72-40.14), 1.48 (1.11, 1.96), 1.74 (1.00-3.03), 1.49 (1.06-2.08), 1.52 (1.07-2.18), 1.43 (0.27, 7.51), 1.46 (1.09, 1.96), 2.58 (1.67-3.97), and 1.52 (0.95-2.42), respectively. We found 6-9, 9-12, and ≥12 years of education that statistically reduced the risk of the occurrence of HCC ( < 0.05) and OR values and 95% CIs were 0.70 (0.58, 0.86), 0.52 (0.40, 0.68), and 0.37 (0.23, 0.59), respectively. No significant associations ( > 0.05) were observed between race (Hispanic and Asian), passive smoking, marital status, place of birth, place of residence, and HCC. In stratified analysis, exposure of pesticide was statistically significant ( < 0.05), while race of black was on the contrary.
CONCLUSION
Environmental and socioeconomic risk factors have great impacts on the incidence rate of HCC. Improving national education and income levels can significantly reduce the risk of HCC.
PROSPERO REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42020151710.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Pesticides; Risk Factors; Socioeconomic Factors; Tobacco Smoke Pollution
PubMed: 35252078
DOI: 10.3389/fpubh.2022.741490