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BMJ Open Feb 2021Our study aimed to systematically review the methodological characteristics of studies that identified prognostic factors or developed or validated models for predicting...
OBJECTIVE
Our study aimed to systematically review the methodological characteristics of studies that identified prognostic factors or developed or validated models for predicting mortalities among patients with acute aortic dissection (AAD), which would inform future work.
DESIGN/SETTING
A methodological review of published studies.
METHODS
We searched PubMed and EMBASE from inception to June 2020 for studies about prognostic factors or prediction models on mortality among patients with AAD. Two reviewers independently collected the information about methodological characteristics. We also documented the information about the performance of the prognostic factors or prediction models.
RESULTS
Thirty-two studies were included, of which 18 evaluated the performance of prognostic factors, and 14 developed or validated prediction models. Of the 32 studies, 23 (72%) were single-centre studies, 22 (69%) used data from electronic medical records, 19 (59%) chose retrospective cohort study design, 26 (81%) did not report missing predictor data and 5 (16%) that reported missing predictor data used complete-case analysis. Among the 14 prediction model studies, only 3 (21%) had the event per variable over 20, and only 5 (36%) reported both discrimination and calibration statistics. Among model development studies, 3 (27%) did not report statistical methods, 3 (27%) exclusively used statistical significance threshold for selecting predictors and 7 (64%) did not report the methods for handling continuous predictors. Most prediction models were considered at high risk of bias. The performance of prognostic factors showed varying discrimination (AUC 0.58 to 0.95), and the performance of prediction models also varied substantially (AUC 0.49 to 0.91). Only six studies reported calibration statistic.
CONCLUSIONS
The methods used for prognostic studies on mortality among patients with AAD-including prediction models or prognostic factor studies-were suboptimal, and the model performance highly varied. Substantial efforts are warranted to improve the use of the methods in this population.
Topics: Aortic Dissection; Bias; Calibration; Humans; Prognosis; Retrospective Studies
PubMed: 33550248
DOI: 10.1136/bmjopen-2020-042435 -
Cancer Epidemiology, Biomarkers &... Feb 2010To summarize existing evidence about whether the presence of mutant or upregulated p53 is a prognostic factor for patients presenting with squamous cell carcinoma... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To summarize existing evidence about whether the presence of mutant or upregulated p53 is a prognostic factor for patients presenting with squamous cell carcinoma arising from the larynx, oropharynx, hypopharynx, or oral cavity.
METHOD
Relevant articles were identified using strict criteria for systematic searches. Associations between mutant or upregulated p53 versus wild-type or low/undetectable p53 in relation to overall survival and DFS were summarized by extracting or deriving hazard ratio (HR) estimates. Random-effects meta-analyses were used to account for between-study heterogeneity and to summarize the effect of p53 across studies.
RESULTS
The meta-analyses gave a statistically significant pooled HR for overall survival in oral cavity [pooled HR, 1.48; 95% confidence interval, (95% CI), 1.03-2.11], and for disease-free survival in oral cavity (pooled HR, 1.47; 95% CI, 1.12-1.93) and in oropharynx (pooled HR, 0.45; 95% CI, 0.27-0.73). Despite attempts to limit it, between-study heterogeneity was large in the majority of meta-analyses and the prognostic value of p53 was generally inconsistent and inconclusive across studies.
CONCLUSION
The meta-analysis results highlight that current evidence about the prognostic value of p53 in patients with squamous cell carcinoma of the head and neck is inconclusive. Large heterogeneity exists across studies in study-level and patient-level characteristics, making it difficult to ascertain a clear picture. Future studies are required in which p53 expression is investigated in a more standardized and biologically informative manner. In particular, prospectively planned individual patient data meta-analyses are needed to establish the prognostic importance of p53 for specific subgroups of patients undergoing specific treatments.
Topics: Biomarkers, Tumor; Carcinoma, Squamous Cell; Disease-Free Survival; Head and Neck Neoplasms; Humans; Prognosis; Tumor Suppressor Protein p53
PubMed: 20142252
DOI: 10.1158/1055-9965.EPI-09-0981 -
Reviews in Endocrine & Metabolic... Dec 2023Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid tumors. However, the role of inflammation markers in differentiated thyroid carcinoma (DTC) is still uncertain.
OBJECTIVE
This meta-analysis aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with DTC.
METHODS
Studies investigating the association between survival and preoperative circulating inflammatory markers in DTC patients were included. The primary outcome was disease-free survival (DFS). Cumulative logarithms of the hazard ratio (log-HRs) with 95% CI were calculated through the inverse variance method using a random-effects model.
RESULTS
A total of 7599 patients with a mean age of 48.89 (95% CI 44.16-53.63) were included. The estimated pooled log-HRs for DFS were 0.07 for NLR (95% CI -0.12-0.26; p = 0.43), -0.58 for LMR (95% CI -1.21-0.05; p = 0.06), and 0.01 (95% CI 0-0.01; p = 0.21) for PLR.
CONCLUSIONS
Our meta-analysis showed no association between NLR, PLR, LMR and DFS in DTC; however, more prospective data are needed to better define the association between inflammatory status and prognosis of DTC.
Topics: Humans; Middle Aged; Prognosis; Prospective Studies; Lymphocytes; Inflammation; Thyroid Neoplasms
PubMed: 37828383
DOI: 10.1007/s11154-023-09845-x -
Anticancer Research Oct 2023Low human epidermal growth factor receptor 2 expression (HER2-low: 1+/2+ by immunohistochemistry without HER2 amplification) is emerging as defining a specific breast... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Low human epidermal growth factor receptor 2 expression (HER2-low: 1+/2+ by immunohistochemistry without HER2 amplification) is emerging as defining a specific breast cancer (BC) subgroup owing to its distinct biological features. However, its prognostic role has not been confirmed in clinical practice. We conducted a systematic review and meta-analysis to determine the prognostic role of HER2-low status in patients with estrogen receptor-positive (ER+) early BC.
MATERIALS AND METHODS
We searched PubMed, EMBASE, and the Cochrane Library for prospective or retrospective studies that reported data on overall (OS) or disease-free (DFS) survival for HER2-low compared to HER2-negative BC. Data were pooled using hazard ratios (HR) with confidence intervals (CI) for OS/DFS of HER2-low vs. HER2-negative subgroups according to the random-effects model. OS was the primary outcome measure, and DFS and pathological complete response were the secondary endpoints.
RESULTS
An analysis was made of 25 studies collected, including 34,965 patients with HER2-low BC. A HER2-low status was associated with an HR for OS of 0.83 (95% CI=0.76-0.9, p<0.0.01). Similarly, a pooled HR of 0.89 (95% CI=0.840.94, p<0.0.01) showed that patients with HER2-low BC had an increased DFS. Pathological complete response was significantly lower in HER2-low BC in 13 studies (OR=0.72, 95% CI=0.58-0.91; p<0.01).
CONCLUSION
Based on these data, HER2-low status should be identified as a potential prognostic factor in early stage ER+ BC. This should be taken into account when considering treatment in (neo)adjuvant settings, and it should be a potential stratification factor in future investigations.
Topics: Humans; Female; Breast Neoplasms; Prognosis; Retrospective Studies; Prospective Studies; Receptor, ErbB-2; Proportional Hazards Models; Disease-Free Survival
PubMed: 37772569
DOI: 10.21873/anticanres.16625 -
Cancer Medicine May 2023It has been proven that tumor necrosis is associated with poor prognoses in various solid malignant tumors. However, the prognostic effect of tumor necrosis in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been proven that tumor necrosis is associated with poor prognoses in various solid malignant tumors. However, the prognostic effect of tumor necrosis in hepato-biliary-pancreatic cancers is still unclear. Therefore, this study was performed to evaluate the associations of tumor necrosis with survival outcomes and clinicopathological features in patients with hepato-biliary-pancreatic cancers.
METHODS
Based on the PRISMA statement, eligible studies were identified from PubMed, Embase, Cochrane Library, and Web of Science from inception until January 2023. The pooled hazard ratios (HRs) and 95% confidence intervals (95%CIs) were calculated to assess the connection between tumor necrosis and hepato-biliary-pancreatic cancers. We then choose which effects model to use to generate pooled HRs and 95% CIs, depending on data heterogeneity.
RESULTS
In total, 6497 articles were identified, 10 of which were included in this meta-analysis. Our results suggested that the presence of tumor necrosis predicted a poorer outcome for overall survival (HR = 1.54, 95% CI = 1.35-1.77, p < 0.001) and recurrence-free survival (HR = 1.69, 95% CI = 1.37-2.08, p < 0.001). In addition, tumor necrosis was correlated with larger tumor size, a higher frequency of lymph node metastasis, poorer histologic differentiation, and higher recurrence and metastasis rates.
CONCLUSION
Our meta-analysis suggests that hepato-biliary-pancreatic cancer patients with tumor necrosis have dismal survival outcomes, and that their tumors have aggressive biological behaviors. Tumor necrosis has the potential to be a promising biomarker for forecasting poor prognosis in these patients.
Topics: Humans; Prognosis; Biomarkers, Tumor; Biliary Tract Neoplasms; Pancreatic Neoplasms; Vascular Diseases; Necrosis
PubMed: 36951535
DOI: 10.1002/cam4.5742 -
Medicine Mar 2018There were many reports suggesting that different kinds of tumors can express B7-H4; however, the prognostic value in cancer was still unclearly. Therefore, we conducted... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There were many reports suggesting that different kinds of tumors can express B7-H4; however, the prognostic value in cancer was still unclearly. Therefore, we conducted a meta-analysis to investigate the relationship between overexpression of B7-H4 with the prognostic value in pancreatic cancer patients.
MATERIALS AND METHODS
The Pubmed, Embase, Cochrane Library, Ovid, Web of Science, and Chinese research database (including CBM, CNKI, and WAN FANG) were searched for related literature published until October 12, 2017. The pooled odds ratios (ORs) and/or pooled hazard ratios (HRs) for clinical pathological factors and overall survival (OS) were calculated and analyzed using Stata software. To assess whether an individual study had an impact on the result, sensitivity analysis was performed for all included individual studies using the fixed-effects model. Publication bias was evaluated using Egger's and Begg's tests.
RESULTS
Data from 6 observational studies including 442 patients were summarized in this meta-analysis, and each study was eligible for inclusion based on included and exclude criteria. The pooled results indicated that the B7-H4 overexpression could predict the presentation of lymph node metastasis (OR = 3.94, 95% CI: 1.22-12.66, P = .022), advanced TNM stage (T = the extent of the primary tumor, N = regional lymph nodes, M = distant metastases) (III+IV vs I+II; OR = 7.63, 95% CI: 2.46-23.66, P < .001), and the poor OS (HR = 3.00, 95%CI = 2.20-4.10, P < .001) in PC patients.
CONCLUSIONS
This study reveals that high expression of B7-H4 is an unfavorable prognostic factor for patients with pancreatic cancer. These results may guide the clinical management of this patient population.
Topics: Biomarkers, Tumor; Humans; Pancreatic Neoplasms; Prognosis; V-Set Domain-Containing T-Cell Activation Inhibitor 1
PubMed: 29561406
DOI: 10.1097/MD.0000000000010088 -
Microvessel density as a prognostic factor in ovarian cancer: a systematic review and meta-analysis.Asian Pacific Journal of Cancer... 2015The prognostic value of microvessel density (MVD), reflecting angiogenesis, detected in ovarian cancer is currently controversial. Here we performed a meta-analysis of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The prognostic value of microvessel density (MVD), reflecting angiogenesis, detected in ovarian cancer is currently controversial. Here we performed a meta-analysis of all relevant eligible studies.
MATERIALS AND METHODS
A comprehensive search of online PubMed, Medline, EMBASE and Sciencedirect was performed to identify all related articles. The search strategy was designed as 'microvessel density', 'ovarian cancer', 'ovarian neoplasm', 'CD34' and 'angiogenesis'.
RESULTS
The studies were categorized by author/year, number of patients, FIGO stage, histology, cutoff value for microvessel density, types of survival analysis, methods of hazard rations (HR) estimation, HR and its 95% confidence interval (CI). Combined hazard ratios suggested that high MVD was associated with poor overall survival (OS) and progression-free survival (PFS), with HR and 95% CIs of 1.84 (1.33-2.35) and 1.36 (1.06-1.66), respectively. Subgroup analysis showed that high MVD detected by CD34 was relevant for OS [HR=1.67 (1.36-2.35)], but not MVD detected with other antibodies [HR=2.11 (0.90-3.31)]. Another subgroup analysis indicated that high MVD in patients without pre-chemotherapy, but not with pre- chemotherapy, was associated with OS [HR=1.88(1.59-2.18 and HR=1.70 (-0.18-3.59)].
CONCLUSIONS
The OS and PFS with high MVD were significant poorer than with low MVD in ovarian cancer patients. However, high MVD detected by CD34 seems to be more associated with survival for patients without pre-chemotherapy.
Topics: Female; Humans; Microvessels; Neovascularization, Pathologic; Ovarian Neoplasms; Prognosis
PubMed: 25735375
DOI: 10.7314/apjcp.2015.16.3.869 -
Urologic Oncology Oct 2021To perform a systematic review and meta-analysis of the Prognostic Nutritional Index (PNI) as a prognostic factor for renal cell carcinoma (RCC). (Meta-Analysis)
Meta-Analysis
PURPOSE
To perform a systematic review and meta-analysis of the Prognostic Nutritional Index (PNI) as a prognostic factor for renal cell carcinoma (RCC).
MATERIALS AND METHODS
Eligible studies that evaluated the prognostic impact of pretreatment PNI in RCC patients were identified by comprehensive searching the electronic databases PubMed, Cochrane Central Search library, and EMBASE. The end points were overall/cancer-specific survival (OS/CSS) and recurrence-free/disease-free survival (RFS/DFS). Meta-analysis using random-effects models was performed to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs).
RESULTS
In total, 9 retrospective, observational, case-control studies involving 5,976 patients were included for final analysis. Eight studies evaluated OS/CSS, and 5 evaluated RFS/DFS. Our results showed that lower PNI was significantly associated with unfavorable OS/CSS (HR = 1.68, 95% CI 1.44-1.96, P < 0.001, I = 9.2%, P = 0.359) and RFS/DFS (HR = 1.98, 95% CI 1.57-2.50, P < 0.001, I = 18.2%, P = 0.299) in patients with RCC. Subgroup and meta-regression analysis based on ethnicity, study sample size, presence of metastasis, PNI cut-off value, Newcastle-Ottawa quality assessment scale (NOS) score, and gender ratio all showed that lower PNI was associated with poorer OS/CSS and RFS/DFS. Funnel plots and Egger's tests indicated significant publication bias in OS/CSS (P = 0.001), but not in RFS/DFS (P = 0.757).
CONCLUSION
This meta-analysis indicated that lower PNI was a negative prognostic factor and associated with tumor progression and poorer survival of patients with RCC. Therefore, PNI could be a potential prognostic predictor of treatment outcomes for patients with RCC.
Topics: Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Male; Nutrition Assessment; Prognosis; Survival Analysis
PubMed: 34253447
DOI: 10.1016/j.urolonc.2021.05.028 -
Neuroradiology Jan 2021Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery.
METHODS
Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity.
RESULTS
Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69-4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04-1.80 and RR 1.76 95% CI 1.38-2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45-2.21 and RR 1.38, 95% CI 1.11-1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98-1.84).
LIMITATIONS
Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study.
CONCLUSIONS
Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.
Topics: Aged; Hematoma, Subdural, Chronic; Humans; Prognosis; Radiography; Recurrence; Risk Assessment
PubMed: 33094383
DOI: 10.1007/s00234-020-02558-x -
Archives of Physical Medicine and... May 2016To summarize the available evidence regarding the course of symptoms and prognostic factors in patients with diagnosed carpal tunnel syndrome (CTS) who are treated... (Review)
Review
OBJECTIVE
To summarize the available evidence regarding the course of symptoms and prognostic factors in patients with diagnosed carpal tunnel syndrome (CTS) who are treated conservatively.
DATA SOURCES
Computerized databases, reference checking, and experts in the field were used to identify studies for inclusion in the review.
STUDY SELECTION
Multiple reviewers were used to identify studies which included adults (aged ≥18y) diagnosed with CTS in either a clinical setting or population setting. The study must have observed the course of CTS over at least a 6-week period in patients receiving no treatment or usual care that included conservative (nonsurgical) treatments. The design was of a longitudinal cohort study with either prospective or retrospective data collection. There were no language restrictions, and none of the research identified was only reported in abstract form.
DATA EXTRACTION
Methodological bias was assessed using the Quality in Prognosis Studies tool. A high risk of bias (predominantly relating to study attrition, confounding, and/or statistical analysis and reporting) was judged to be present in 8 studies. Designs showed wide variability with respect to characteristics of the included population, definition of CTS, assessment of prognostic factors, types of interventions provided, and types of outcome measures applied. This prevented pooled estimates from being produced.
DATA SYNTHESIS
A negative outcome at 3 years' follow-up of conservatively treated participants ranged from 23% to 89%. Four included studies observed the rate of surgical intervention after initial conservative management and found this to be 57% to 66%. Evidence regarding factors predicting the negative outcome of no treatment or conservative treatment was graded, taking into account the number of studies evaluating the factor, the methodological quality of these studies, and the consistency of the available evidence. There was 100% agreement in at least 3 cohorts with a medium or high risk of bias that symptom duration, a positive Phalen's test, and thenar wasting were associated with a negative outcome of conservative management; however, not all results were statistically significant, and hence the overall judgment remained inconclusive.
CONCLUSIONS
Results of this review should be treated with caution because of the heterogeneity of studies and the risks of bias identified. However, the course of CTS appears variable, and poor prognosis may be predicted by a longer symptom duration, a positive Phalen's test, and thenar wasting.
Topics: Adult; Aged; Carpal Tunnel Syndrome; Conservative Treatment; Female; Humans; Longitudinal Studies; Male; Middle Aged; Prognosis; Prospective Studies; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 26440776
DOI: 10.1016/j.apmr.2015.09.013