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Phytomedicine : International Journal... Jul 2023Aidi injection (Aidi), a traditional Chinese medicine injection, is often practiced to control malignant pleural effusion (MPE). (Meta-Analysis)
Meta-Analysis
The evidence framework of traditional Chinese medicine injection (Aidi injection) in controlling malignant pleural effusion: A clustered systematic review and meta-analysis.
INTRODUCTION
Aidi injection (Aidi), a traditional Chinese medicine injection, is often practiced to control malignant pleural effusion (MPE).
OBJECTIVES
We performed a registered systematic review and meta-analysis (PROSPERO: CRD42022337611) to clarify the clinical role of Aidi in MPE, reveal optimal combinations of Aidi and chemical agents, their indications, therapeutic route and usage, and demonstrate their clinical effectiveness and safety.
METHODOLOGY
All randomized controlled trials (RCTs) about Aidi in controlling MPE were collected from Chinese and English databases (up to October 2022). We clustered them into multiple homogenous regimens, evaluated the risk-of-bias at outcome level using a RoB 2, extracted and pooled the data using meta-analysis or descriptive analysis, and finally summarized their evidence quality.
RESULTS
All 56 studies were clustered into intrapleural administration with Aidi alone or plus chemical agents, and intravenous administration with Aidi for MPE. Intrapleural administration with Aidi alone displayed similar clinical responses on Cisplatin (DDP) alone. Only administration with Aidi plus DDP significantly improved complete response and quality of life, and displayed a low pleurodesis failure, disease progression, hematotoxicity, gastrointestinal and hepatorenal toxicity. For patients with moderate to massive effusion, Karnofsky Performance Status score ≥ 50 or anticipated survival time ≥3 months, Aidi (50 ml to 80 ml each time, one time each week and three to eight times) plus DDP (20 to 30 mg, 40 to 50 mg, or 60 to 80 mg each time) significantly improved clinical responses. Most results had moderate to low quality.
CONCLUSIONS
Current evidences indicate that Aidi, a pleurodesis agent, plays an interesting clinical role in controlling MPE. Aidi plus DDP perfusion is a most commonly used regimen, which shows a significant improvement in clinical responses. These findings also provide an indication and possible optimal usage for rational drug use.
Topics: Humans; Lung Neoplasms; Medicine, Chinese Traditional; Pleural Effusion, Malignant; Drugs, Chinese Herbal; Cisplatin
PubMed: 37149965
DOI: 10.1016/j.phymed.2023.154847 -
Lung Cancer (Amsterdam, Netherlands) Dec 2021The role of PET and integrated PET-CT in the diagnostic workup of suspected malignant pleural effusions is unknown. Earlier systematic reviews (published 2014 and 2015)... (Meta-Analysis)
Meta-Analysis Review
The role of PET and integrated PET-CT in the diagnostic workup of suspected malignant pleural effusions is unknown. Earlier systematic reviews (published 2014 and 2015) both included pleural pathology without effusion, and reached contradictory conclusions. Five studies have been published since the latest review. This systematic review and meta-analysis aims to summarise the evidence of PET and integrated PET-CT in predicting pleural malignancy in patients suspected of having malignant pleural effusions. A meta-analysis based on a systematic literature search in Cochrane Library, Medline, EMBASE and Clinicaltrials.gov was performed. Diagnostic studies evaluating the performance of PET or PET-CT in patients with suspected malignant pleural effusion, using pleural fluid cytology or histopathology as the reference test, and presenting sufficient data for constructing a 2x2 table were included. The quality of the studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 score. Subgroup analyses on image modality, interpretation method and known malignancy status pre index-test application were planned. Seven studies with low risk of bias were included. The pooled ability to separate benign from malignant effusions varied with image modality, interpretation method and known malignancy status pre index-test application. In studies using PET-CT, visual/qualitative image analysis was superior to semi-quantitative with positive (LR + ) and negative likelihood ratio (LR-) of 9.9 (4.5-15.3) respectively 0.1 (0.1-0.2). There was considerable heterogeneity among studies. In conclusion, visual/qualitative image analysis of integrated PET-CT seems to add relevant information in the work-up of suspected malignant pleural effusions with LR + and LR- close to rigorous pre-set cut-offs of > 10 and < 0.1. However, the quality of evidence was low due to inter-study heterogeneity, and inability to assess meta-bias. Clinical Trial Registration: The protocol was uploaded to the PROSPERO database (CRD42020213319) on the 13th of October 2020.
Topics: Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Pleural Effusion; Pleural Effusion, Malignant; Pleural Neoplasms; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 34775214
DOI: 10.1016/j.lungcan.2021.10.018 -
Respiration; International Review of... 2012Eosinophilic pleural effusion (EPE) is defined by an eosinophil count of ≥10% in the pleural fluid and often caused by air or blood in the pleural space. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Eosinophilic pleural effusion (EPE) is defined by an eosinophil count of ≥10% in the pleural fluid and often caused by air or blood in the pleural space. The diagnostic significance of EPEs is still a matter of debate.
OBJECTIVE
The objective of this study was to systematically review the medical literature to evaluate the diagnostic significance of EPEs.
METHODS
Electronic databases were searched from 1950 to April 2010 to perform a meta-analysis. Data were extracted using standardized forms, and pooled odds ratios with 95% confidence intervals were calculated. A logistic regression analysis was also performed to evaluate the association between the pleural eosinophil counts and the likelihood of underlying causes of EPEs.
RESULTS
We identified a total of 687 cases of EPE. The most common cause of EPEs was malignancy (26%) followed by idiopathic (25%) and parapneumonic (13%) effusions. The likelihood of malignancy or tuberculosis was somehow lower in EPEs than in non-EPEs, but the differences were not statistically significant. The prevalence of malignancy was significantly lower in the group of patients that required a pathologic confirmation (21 vs. 30%; p = 0.01). The likelihood of malignancy was inversely correlated with the pleural fluid eosinophil counts. The likelihood of idiopathic effusion was significantly higher in EPEs than in non-EPEs.
CONCLUSIONS
Malignancy was the most common cause of EPEs. EPEs appeared to be a negative predictor of malignancy when a pleural fluid eosinophil count was extremely high. EPEs were more likely to be idiopathic as compared with non-EPEs.
Topics: Collagen Diseases; Eosinophilia; Humans; Pleural Effusion; Pleural Effusion, Malignant; Prevalence; Pulmonary Embolism; Tuberculosis; Vascular Diseases
PubMed: 21576924
DOI: 10.1159/000327200 -
European Respiratory Review : An... Dec 2021Malignant pleural mesothelioma (MPM) is characterised by late-stage diagnosis and poor prognosis. Currently, no screening tool is advocated and diagnosis is based on... (Meta-Analysis)
Meta-Analysis Review
Malignant pleural mesothelioma (MPM) is characterised by late-stage diagnosis and poor prognosis. Currently, no screening tool is advocated and diagnosis is based on invasive techniques, which are not well tolerated. Non-invasive diagnostic biomarkers have shown potential and could have a huge clinical benefit. However, despite extensive research, there is no consensus yet on their clinical use, with many articles reporting contradicting results, limiting their clinical implementation. The aim of this systematic review is therefore to explore the different semi- and non-invasive diagnostic markers in several human matrices and identify those that might clinically be relevant. A total of 100 articles were selected through Web of Science and PubMed, with 56 articles included in the quantitative analysis. Although many studies have reported on the diagnostic accuracy of MPM biomarkers such as serum mesothelin and high-mobility group box protein 1 and plasma fibulin-3, none have resulted in a validated test for early detection. Future research should focus on external validation, combinations into biomarker panels, the inclusion of early stage MPM patients and a combination of different biomarker matrices, as well as new markers.
Topics: Biomarkers, Tumor; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Prognosis
PubMed: 34789461
DOI: 10.1183/16000617.0057-2021 -
General Thoracic and Cardiovascular... May 2021Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions.
METHODS
We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study.
RESULTS
Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); P = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); P < 0.0001], and bleomycin [RR (95% CI) 1.22 (1.05, 1.42); P = 0.008]. The comparison between talc pleurodesis and controls at the > 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); P = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results.
CONCLUSION
Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.
Topics: Bleomycin; Humans; Pleural Effusion, Malignant; Pleurodesis; Talc
PubMed: 33222091
DOI: 10.1007/s11748-020-01549-2 -
Annals of the American Thoracic Society Jan 2019Several randomized trials have compared the efficacy of an indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of... (Meta-Analysis)
Meta-Analysis
RATIONALE
Several randomized trials have compared the efficacy of an indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of malignant pleural effusion (MPE).
OBJECTIVES
As part of the American Thoracic Society's guidelines for management of MPE, we performed a systematic review and a meta-analysis to compare patient-centered outcomes with the use of a tunneled pleural catheter versus chemical pleurodesis for the first-line treatment of malignant pleural effusions.
METHODS
We performed literature searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing IPC and pleurodesis in adult patients with symptomatic MPE. Risk of bias was assessed with the Cochrane Risk of Bias tool recommended by the Cochrane Methods Bias Group. The meta-analysis was performed with Review Manager software, using a random effects model. We used risk ratios (RRs) with 95% confidence interval (CI) as the effect measure for dichotomous outcomes and mean differences for continuous outcomes.
RESULTS
We identified five randomized trials, involving 545 patients, that compared IPC and pleurodesis. Lack of blinding and the inevitable attrition of patients due to death resulted in an overall high risk of bias among the studies. No differences in survival or measures of dyspnea were observed in any of the studies. Total hospital length of stay was shorter, and repeat pleural interventions were less common in the IPC group (RR, 0.32; 95% CI, 0.18-0.55). However, the risk of cellulitis was higher with IPC (RR, 5.83; 95% CI, 1.56-21.8). No differences were noted in other adverse events.
CONCLUSIONS
Compared with chemical pleurodesis, IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis. Careful assessment of individual patient preferences and costs should be considered when choosing between IPC and pleurodesis.
Topics: Catheterization; Catheters, Indwelling; Humans; Pleural Effusion, Malignant; Pleurodesis; Randomized Controlled Trials as Topic; Talc
PubMed: 30272486
DOI: 10.1513/AnnalsATS.201807-495OC -
American Journal of Therapeutics 2016Tunneled pleural catheter (TPC) has been widely used to control malignant pleural effusion (MPE); however, it is still not clear whether it is more effective than... (Comparative Study)
Comparative Study Meta-Analysis Review
Tunneled pleural catheter (TPC) has been widely used to control malignant pleural effusion (MPE); however, it is still not clear whether it is more effective than chemical pleurodesis. We performed a systematic review with meta-analysis to evaluate success and complication rate of TPC as compared with chemical pleurodesis in the management of MPE. PubMed, EMBASE, Cochrane central register of controlled trials, and MEDLINE were searched for English-language studies of clinical controlled trials comparing TPC with chemical pleurodesis until May 2014. Overall success and complication rate were evaluated. Relative risks (RRs) were estimated using random-effects model, and statistical heterogeneity was assessed using I test. Three trials involving 307 patients with MPE were included. The success rate was comparable between TPC and chemical pleurodesis group when all studies included in the analysis (RR, 0.8; 95% confidence interval, 0.53-1.19; P = 0.27). TPC had slightly higher complication rate but was not statistically significant (RR, 2; 95% confidence interval, 0.91-4.4; P = 0.09). Current evidence suggests that TPC and chemical pleurodesis are both effective treatment for recurrent MPE with similar success and complication rate. Further randomized controlled trials are needed to compare TPC with other therapies in patients with MPE.
Topics: Catheterization; Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis; Treatment Outcome
PubMed: 25654292
DOI: 10.1097/MJT.0000000000000197 -
Academic Radiology Jan 2014To systematically review and meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)... (Comparative Study)
Comparative Study Meta-Analysis Review
RATIONALE AND OBJECTIVES
To systematically review and meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the differential diagnosis between malignant and benign pleural lesions.
METHODS AND MATERIALS
A comprehensive literature search of studies published through June 2013 regarding the diagnostic performance of (18)F-FDG-PET and PET/CT in the differential diagnosis of pleural lesions was carried out. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) of (18)F-FDG-PET or PET/CT in the differential diagnosis of pleural lesions on a per-patient-based analysis were calculated. The area under the summary receiver operating characteristic curve (AUC) was calculated to measure the accuracy of these methods. Subanalyses considering device used (PET or PET/CT) were performed.
RESULTS
Sixteen studies including 745 patients were included in the systematic review. The meta-analysis of 11 selected studies provided the following results: sensitivity 95% (95% confidence interval [95%CI]: 92-97%), specificity 82% (95%CI: 76-88%), LR+ 5.3 (95%CI: 2.4-11.8), LR- 0.09 (95%CI: 0.05-0.14), DOR 74 (95%CI: 34-161). The AUC was 0.95. No significant improvement of the diagnostic accuracy considering PET/CT studies only was found.
CONCLUSIONS
(18)F-FDG-PET and PET/CT demonstrated to be accurate diagnostic imaging methods in the differential diagnosis between malignant and benign pleural lesions; nevertheless, possible sources of false-negative and false-positive results should be kept in mind.
Topics: Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Humans; Male; Multimodal Imaging; Pleural Diseases; Pleural Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 24331260
DOI: 10.1016/j.acra.2013.09.015 -
Clinica Chimica Acta; International... Jun 2014Osteopontin has been viewed as a promising biomarker for malignant pleural mesothelioma (MPM); however, the conclusions of various studies on diagnostic accuracy of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Osteopontin has been viewed as a promising biomarker for malignant pleural mesothelioma (MPM); however, the conclusions of various studies on diagnostic accuracy of osteopontin have not been consistent. The aim of this study was to conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of circulating osteopontin for MPM.
METHODS
Using appropriate key words, scientific literature that evaluated circulating levels of osteopontin for the diagnosis of MPM was retrieved from electronic databases. Only articles published in English till March 26, 2013 were included in this study. The quality of the studies was assessed using the revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tools. The random-effects models were applied for analysing the performance of pooled characteristics.
RESULTS
Six studies were included in the analysis. The overall diagnostic sensitivity and specificity were 0.65 (95% CI: 0.60-0.70) and 0.81 (95% CI: 0.78-0.85), respectively. The area under summary receiver operating characteristic (sROC) curves (AUC) was 0.83. The diagnostic accuracy of serum and plasma osteopontin was comparable.
CONCLUSIONS
Osteopontin is an effective marker for MPM diagnosis. However, more studies with a larger sample size and better design are needed to rigorously assess the diagnostic power of osteopontin.
Topics: Biomarkers, Tumor; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Osteopontin; Sensitivity and Specificity
PubMed: 24607327
DOI: 10.1016/j.cca.2014.02.024 -
Thoracic Cancer Apr 2022Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though... (Review)
Review
Hyperthermic intrathoracic chemotherapy for the treatment of malignant pleural effusion caused by breast and ovarian cancer: A systematic literature review and pooled analysis.
OBJECTIVES
Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer.
METHODS
A systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included.
RESULTS
Thirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low.
CONCLUSIONS
Intrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.
Topics: Breast Neoplasms; Female; Humans; Hyperthermia, Induced; Ovarian Neoplasms; Pleural Effusion, Malignant; Pleurodesis
PubMed: 35194945
DOI: 10.1111/1759-7714.14361