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World Journal of Urology Jan 2020Numerous recent studies have shown that concomitant carcinoma in situ (CIS) can be closely associated with the prognosis of patients with bladder cancer (BCa). However,... (Meta-Analysis)
Meta-Analysis
Concomitant carcinoma in situ may not be a prognostic factor for patients with bladder cancer following radical cystectomy: a PRISMA-compliant systematic review and meta-analysis.
BACKGROUND
Numerous recent studies have shown that concomitant carcinoma in situ (CIS) can be closely associated with the prognosis of patients with bladder cancer (BCa). However, the prognostic value of CIS in BCa is still not conclusive. Hence, we performed a systematic review and meta-analysis to explore the association between CIS and clinicopathological features and the prognostic value for BCa following radical cystectomy.
METHODS
We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were systematically collected from PubMed, EMBASE, and Web of Science, with an expiration date of August 2018. Hazard ratios and 95% confidence intervals (CIs) were pooled to assess the intensity of association. All data were analyzed by Stata 12.0. Moreover, heterogeneity and publication bias were determined, and sensitivity analysis was performed to examine whether the findings of the meta-analysis were robust.
RESULTS
A total of 18,845 patients from 24 studies were included in the analysis. Our results indicated that CIS has no significant correlation with cancer-specific mortality (CSM) (pooled HR = 0.97, 95% CI 0.93-1.00, p = 0.059), overall mortality (OM) (pooled HR = 0.93, 95% CI 0.85-1.01, p = 0.076), overall survival (OS) (pooled HR = 1.04, 95% CI 0.96-1.12, p = 0.386), cancer-specific survival (CSS) (pooled HR = 1.06, 95% CI 0.97-1.16, p = 0.186), recurrence-free survival (RFS) (HR = 1.05, 95% CI 0.99-1.11, p = 0.098) or recurrence (pooled HR = 1.04, 95% CI 0.98-1.11, p = 0.212) in BCa patients. In addition, CIS was not correlated with gender (male vs. female, OR = 1.00, 95% CI 0.74-1.34, p = 0.978), pathological stage (III/IV vs. I/II: OR = 0.74, 95% CI 0.50-1.10, p = 0.132), tumor grade (1/2 vs. 3: OR = 3.38, 95% CI 0.73-15.65, p = 0.119), soft tissue surgical margin (STSM) (+ vs. - : OR = 1.20, 95% CI 0.97-1.48, p = 0.093) or lymphovascular invasion (LVI) (+ vs. - : OR = 0.92, 95% CI 0.62-1.38, p = 0.702),but was closely related to adjuvant chemotherapy (ACT) (yes vs. no, OR = 1.17, 95% CI 1.03-1.32, p = 0.019). Furthermore, these findings were demonstrated to be reliable by our sensitivity and subgroup analysis.
CONCLUSIONS
The prognostic value of CIS in BCa remains inconclusive in patients submitted to RC. Our data indicated that CIS may have no significant correlation with the prognosis and clinicopathological parameters of BCa patients, and also may not be applied to risk stratification or individualized therapy in BCa patients. Further research should be conducted to confirm our findings.
Topics: Carcinoma in Situ; Cystectomy; Humans; Margins of Excision; Neoplasm Grading; Prognosis; Urinary Bladder Neoplasms
PubMed: 30919100
DOI: 10.1007/s00345-019-02738-2 -
Annals of Surgical Oncology Oct 2015We aimed to elucidate the relation between extracapsular extension (ECE) and clinical outcomes in node-positive patients following radical cystectomy for bladder cancer. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We aimed to elucidate the relation between extracapsular extension (ECE) and clinical outcomes in node-positive patients following radical cystectomy for bladder cancer.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases from their respective dates of inception until September 2014.
RESULTS
Ten articles that met the eligibility criteria included 43-748 subjects per study, with the total number of patients being 1,893. The frequency of ECE ranged from 36.6 to 58.1 %. The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (RFS) [pooled HR 1.56; 95 % confidence interval (CI) 1.13-2.14] and cancer-specific survival (CSS) (pooled HR 1.60; 95 % CI 1.29-1.99) but not overall survival (OS) (pooled HR 1.47; 95 % CI 0.71-3.05). Heterogeneity in RFS (I (2) 84 %, p < 0.00001) and OS (I (2) 80 %, p = 0.03) was statistically significant. According to subgroup analysis with meta-regression analyses, "region" (pheterogeneity < 0.0001) and "analysis results" (pheterogeneity < 0.0001) were the sources of heterogeneity. Sensitivity analysis showed that omission of any study did not lead to a significant difference. No statistical evidence of publication bias regarding RFS or CSS was revealed among the studies using Begg's and Egger's tests.
CONCLUSIONS
This meta-analysis shows that ECE is an efficient prognostic factor for node-positive bladder cancer. However, large prospective studies are needed to confirm the clinical utility of ECE as an independent prognostic factor before these results can be applied clinically.
Topics: Disease-Free Survival; Humans; Lymph Nodes; Lymphatic Metastasis; Pelvis; Survival Rate; Urinary Bladder Neoplasms
PubMed: 25613388
DOI: 10.1245/s10434-014-4359-1 -
Cancer Research May 2004We performed a meta-analysis of all 87 published studies linking intratumoral microvessel density (MVD), reflecting angiogenesis, to relapse-free survival (RFS) and... (Meta-Analysis)
Meta-Analysis Review
We performed a meta-analysis of all 87 published studies linking intratumoral microvessel density (MVD), reflecting angiogenesis, to relapse-free survival (RFS) and overall survival (OS). With median MVD as cutoff, MVD impact was measured by risk ratio (RR) between the two survival distributions. Seventeen studies did not mention survival data or fit inclusion criteria. Twenty-two were multiple publications of the same series, leaving 43 independent studies (8936 patients). MVD was assessed by immunohistochemistry, using antibodies against factor VIII (27 studies; n = 5262), CD31 (10 studies; n = 2296), or CD34 (8 studies; n = 1726). MVD might be a better prognostic factor when assessed by CD31 or CD34 versus factor VIII (P = 0.11). For RFS, statistical calculations were performed in 25 studies (6501 patients). High MVD significantly predicted poor survival [RR = 1.54 for RFS and OS with the same 95% confidence interval (CI), 1.29-1.84]. Twenty-two studies analyzed separately lymph node-negative patients (n = 3580), for whom predictors of poor survival are requested. This latter meta-analysis included 15 studies for RFS (2727 patients) and 11 for OS (1926 patients). High MVD significantly predicted poor survival [RR = 1.99 for RFS (95% CI, 1.33-2.98) and RR = 1.54 for OS (95% CI, 1.01-2.33)]. Between-study variations could result from patient selection criteria, techniques to stain and count microvessels, and cutoff selection. MVD was a significant although weak prognostic factor in women with breast cancer. Standardization of MVD assessment is needed.
Topics: ADP-ribosyl Cyclase; ADP-ribosyl Cyclase 1; Antigens, CD; Breast Neoplasms; Disease-Free Survival; Factor VIII; Female; Humans; Immunohistochemistry; Membrane Glycoproteins; Platelet Endothelial Cell Adhesion Molecule-1; Survival Rate
PubMed: 15126324
DOI: 10.1158/0008-5472.can-03-1957 -
Chest Jan 2010Little is known about the optimal management of impending paradoxical embolism (IPDE), a biatrial thromboembolus caught in transit across a patent foramen ovale. Our aim... (Review)
Review
BACKGROUND
Little is known about the optimal management of impending paradoxical embolism (IPDE), a biatrial thromboembolus caught in transit across a patent foramen ovale. Our aim was to review observational studies on this subject to identify prognostic factors and to compare mortality and systemic embolism between treatments.
METHODS
Systematic literature searches in Medline, Embase, and Cochrane Library identified 154 studies (174 patients). The primary end point was 30-day mortality. The secondary end point was systemic embolism during treatment.
RESULTS
Thirty-day mortality was 18.4%. On univariate analysis, age (64+/-13.9 vs 56.7+/-16.5; P = .01), coma (12.9% vs 2.2%; P = .02), and systemic embolism (71.9% vs 51.4%; P = .048) at presentation were significantly increased among nonsurvivors. Surgical thromboembolectomy had lower mortality than other treatment groups (10.6%; P = .04). In multivariable models, no prognostic factor was a significant independent predictor of mortality. Surgically treated patients had nonsignificantly reduced mortality (odds ratio [OR], 0.65 [0.24-1.72]; P = .65) and thrombolysis-treated patients had increased mortality (OR, 1.62 [0.43-5.97]; P = .47). However, systemic embolism during treatment and combined mortality and systemic embolism was decreased in the surgery group (OR, 0.13 [0.03-0.67]; P = .02 and OR, 0.26 [0.11-0.60]; P = .001).
CONCLUSIONS
This review attempts to help guide what to do in IPDE, despite severe limitations of the methods. Surgical thromboembolectomy showed a nonsignificant trend toward improved survival, significantly reduced systemic embolism, and composite of mortality and systemic embolism, compared with anticoagulation alone. Thrombolysis, on the other hand, had the opposite effect, although not significantly.
Topics: Embolectomy; Embolism, Paradoxical; Foramen Ovale, Patent; Humans; Prognosis; Risk Factors; Survival Rate; Thrombolytic Therapy
PubMed: 19592472
DOI: 10.1378/chest.09-0961 -
Future Oncology (London, England) Jan 2021Using circulating tumor DNA (ctDNA) instead of historical clinicopathological factors to select patients for adjuvant chemotherapy (ACT) may reduce inappropriate... (Meta-Analysis)
Meta-Analysis
Using circulating tumor DNA (ctDNA) instead of historical clinicopathological factors to select patients for adjuvant chemotherapy (ACT) may reduce inappropriate therapy. MEDLINE was searched on 31 March 2020. Studies, including data related to the prognostic value of ctDNA in the colon cancer patients after surgery and after ACT, were included. The generic inverse-variance method with a random-effects model was used for meta-analysis. Four studies were included for this meta-analysis. ctDNA-positive colon cancer patients after surgery and ACT had a significantly increased risk of recurrence compared with ctDNA-negative patients. ctDNA is an independent prognostic factor, and this meta-analysis is a significant step for using ctDNA instead of historical prognostic factors in the adjuvant setting.
Topics: Biomarkers, Tumor; Chemotherapy, Adjuvant; Circulating Tumor DNA; Colonic Neoplasms; Disease-Free Survival; Humans; Neoplasm, Residual; Prognosis
PubMed: 33356539
DOI: 10.2217/fon-2020-0671 -
Annals of Palliative Medicine Apr 2021Nowadays, controlling nutritional status (CONUT) has been used as a prognostic factor in variety of cancers. However, no consensus has been reached on the prognostic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nowadays, controlling nutritional status (CONUT) has been used as a prognostic factor in variety of cancers. However, no consensus has been reached on the prognostic value of CONUT in lung cancer. In this study, we aim to investigate the role of CONUT in survival of patients with lung cancer.
METHODS
EMBASE, web of science, and Medline were used to search articles in English-language journals. The association between CONUT score and survival of patients with lung cancer was evaluated by using pooled HRs and their 95% CIs. Chi-square test and I-Square was used to test heterogeneity among studies. Analyses were all performed using Stata 13.0 (Stata Corporation, College Station, TX).
RESULTS
Eight studies with 1,836 patients were eventually included in this meta-analysis. The pooled results showed that high CONUT score had an unfavorable impact on OS (HR =1.63, 95% CI: 1.30-2.04), DFS (HR =1.75, 95% CI: 1.35-2.26), CSS (HR =1.45, 95% CI: 1.01-2.07) and PFS (HR =1.67, 95% CI: 0.99-2.35), compared with those with low-CONUT.
CONCLUSIONS
CONUT can be used as a predictor of prognosis in patients with lung cancer. High-CONUT score was significantly associated with poor OS, DFS, CSS and PFS.
Topics: Humans; Lung Neoplasms; Nutritional Status; Prognosis; Retrospective Studies
PubMed: 33548999
DOI: 10.21037/apm-20-2328 -
Pathology, Research and Practice Mar 2021Several studies suggested that high expression of Bcl2 and/or p53 in Hodgkin/Reed-Sternberg cells is an unfavorable prognostic factor in Hodgkin lymphoma (HL). However,... (Meta-Analysis)
Meta-Analysis
AIMS
Several studies suggested that high expression of Bcl2 and/or p53 in Hodgkin/Reed-Sternberg cells is an unfavorable prognostic factor in Hodgkin lymphoma (HL). However, results in this field appear contrasting. We aimed to assess the prognostic value of p53 and Bcl2 in HL through a systematic review and meta-analysis.
METHODS
Electronic databases were searched from January 2000 to December 2020 for all studies assessing the prognostic value of p53 and Bcl2 in HL. The association of high p53 or Bcl2 expression with overall survival (OS), progression-free survival (PFS) and response to treatment was assessed by using hazard ratio (HR) and odds ratio (OR).
RESULTS
Eighteen studies were included. Bcl2 overexpression was significantly associated with decreased PFS (HR = 2.202; p < 0.0001), while the associations with decreased OS (HR = 1.565; p = 0.257) and refractoriness to treatment (OR = 0.482; p = 0.068) were non-significant. p53 overexpression was not significantly associated with refractoriness to treatment (OR = 0.904; p = 0.155); the analysis of OS and PFS was not feasible, but published data suggested the absence of a significant association.
CONCLUSIONS
In HL, Bcl2 overexpression is associated with decreased PFS, while a significant prognostic value could not be demonstrated for p53. Defining optimal criteria for interpreting Bcl2 and p53 immunostaining is necessary to draw definitive conclusions.
Topics: Chemoradiotherapy; Disease-Free Survival; Hodgkin Disease; Humans; Lymphoma, Large B-Cell, Diffuse; Prognosis; Proto-Oncogene Proteins c-bcl-2; Tumor Suppressor Protein p53
PubMed: 33618247
DOI: 10.1016/j.prp.2021.153370 -
Critical Reviews in Oncology/hematology Dec 2017The predictive role of excision repair cross-complementing group 1 (ERCC1) as a predictive factor in patients with advanced urothelial cancer (AUC) treated with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The predictive role of excision repair cross-complementing group 1 (ERCC1) as a predictive factor in patients with advanced urothelial cancer (AUC) treated with platinum-based treatment is not well defined. Here, we evaluate the role of ERCC1 in patients with AUC treated with platinum-based treatment.
METHODS
We performed comprehensive, systematic computerized search to identify relevant studies through Medline, Embase, Cochrane Controlled Trials Register (CCTR) databases and abstracts from American Society of Clinical Oncology (ASCO) and ASCO Genitourinary Cancers Symposium, European Society For Medical Oncology (ESMO) and European Association of Urology (EAU) meeting up to July 2015. A systematic review and meta-analysis were performed.
RESULTS
We included a total of 1475 patients from 13 studies. We found that ERCC1 positivity was significantly associated with worse progression-free survival (pooled HR: 1.54, 95% CI: 1.13-2.11, p=0.006). There was no significant association with overall survival (pooled HR1.63, 95% CI: 0.93-2.88, p=0.09) and disease-free survival (pooled HR: 1.092, 95% CI: 0.63-1.90, p=0.75).
CONCLUSION
ERCC1 positivity might be a prognostic indicator for poorer survival outcomes among patients with AUC. ERCC1 positivity was trending to poorer OS but was statistically worse for PFS. Further large prospective studies are warranted as ERCC1 could be used as a predictive marker to direct treatment of patients with AUC.
Topics: Antineoplastic Combined Chemotherapy Protocols; DNA-Binding Proteins; Disease-Free Survival; Endonucleases; Humans; Organoplatinum Compounds; Prognosis; Prospective Studies; Randomized Controlled Trials as Topic; Urinary Bladder Neoplasms; Urologic Neoplasms
PubMed: 29198325
DOI: 10.1016/j.critrevonc.2017.10.012 -
World Journal of Surgical Oncology Nov 2022Many studies have reported the relationship between prognosis and Slug protein expression in breast cancer patients, but the results are discrepant. Therefore, there is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many studies have reported the relationship between prognosis and Slug protein expression in breast cancer patients, but the results are discrepant. Therefore, there is a need for meta-analyses with high statistical power to investigate and further explore their relationship.
METHODS
We used PubMed, Embase, the Cochrane Library, Scopus, MEDLINE, and the Web of Science to find studies on breast cancer and Slug. Overall survival (OS) and disease-free survival (DFS) were the study's primary endpoints. We pooled hazard ratios (HRs) and odds ratios (ORs) to assess the association between Slug protein expression and prognostic and clinicopathological parameters. This study was performed using STATA version 14.0 for data analysis. (Stata Corporation, TX, USA).
RESULTS
We conducted a literature search by searching six online databases. Ultimately, we obtained eight studies including 1458 patients through strict exclusion criteria. The results showed that increased Slug protein expression resulted in poorer OS (HR = 2.21; 95% CI = 1.47-3.33; P < 0.001) and DFS (HR = 2.03; 95% CI = 1.26-3.28; P = 0.004) in breast cancer patients. In addition, the results suggested that breast cancer patients with increased Slug protein expression had a higher TNM stage (I-II vs III-IV; OR = 0.42; 95% CI = 0.25-0.70; P = 0.001), a greater tendency to have axillary lymph node metastases (N+ vs N0; OR = 2.16; 95% CI = 1.31-3.56; P = 0.003) and were more prone to estrogen receptor deficiency (positive vs negative; OR = 0.67; 95% CI = 0.45-0.99; P = 0.042). However, Slug protein expression was not associated with age, histological grade, tumor size, progesterone receptor status, or human epidermal growth factor receptor 2 status in breast cancer patients.
CONCLUSION
This meta-analysis showed that elevated Slug protein expression may be related to poor outcomes in patients with breast cancer. Therefore, Slug is not only an indicator of patient survival but may also become a new target for breast cancer therapy.
Topics: Humans; Female; Prognosis; Breast Neoplasms; Disease-Free Survival; Lymphatic Metastasis; Receptors, Estrogen
PubMed: 36372891
DOI: 10.1186/s12957-022-02825-6 -
Cancer Treatment and Research... 2020KRAS (Kirsten Rat Sarcoma) is the most common oncogenic mutation detected in patients with non-small cell lung cancer (NSCLC). However, the role of KRAS as either a... (Meta-Analysis)
Meta-Analysis
KRAS (Kirsten Rat Sarcoma) is the most common oncogenic mutation detected in patients with non-small cell lung cancer (NSCLC). However, the role of KRAS as either a prognostic factor or predictive factor (modifier of treatment effects) in NSCLC is not well established at this time. This systematic literature review (SLR) and meta-analysis synthesized the available evidence regarding the role of KRAS mutation as a predictive factor and/or prognostic factor of survival and response outcomes in patients with advanced/metastatic (stage IIIB-IV) NSCLC. Relevant clinical trials and observational studies were identified by searching MEDLINE, Embase and Cochrane Register of Controlled Trials. Meta-analyses were performed using data extracted from multivariable and univariable analyses from clinical studies to assess the empirical evidence of KRAS mutation status as a prognostic or/and predicitive factor. 43 selected studies were identified by the SLR and included in this meta-analysis. Pairwise meta-analyses of hazard ratios (HRs) reported in randomized controlled trials (RCTs) did not demonstrate a significant prognostic effect of mutant KRAS on overall survival (OS) (HR=1.10; 95% CI [0.88, 1.38]) or progression free survival (PFS) (HR=1.03; 95% CI [0.80, 1.33]). However, when conducting meta-analyses on HRs reported in observational studies, a statistically significant negative prognostic effect of mutant KRAS was observed (OS HR=1.71; 95% CI [1.07, 2.84]; PFS HR=1.18; 95% CI [1.02, 1.36]). Meta-analyses of objective response rate (ORR) in RCTs demonstrated a negative prognostic effect of mutant KRAS (RR=0.38; 95% CI [0.16, 0.63]). Limited data were available to evaluate the role of KRAS mutation as a predictive factor. In conclusion, this research offers evidence that KRAS mutation may be a negative prognostic factor for survival and response outcomes in patients with advanced/metastatic NSCLC, but further research is needed to address conflicting results on the importance of KRAS mutations as a predictive factor.
Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; DNA Mutational Analysis; ErbB Receptors; Humans; Lung Neoplasms; Mutation; Neoplasm Staging; Observational Studies as Topic; Prognosis; Progression-Free Survival; Protein Kinase Inhibitors; Proto-Oncogene Proteins p21(ras); Randomized Controlled Trials as Topic
PubMed: 32750661
DOI: 10.1016/j.ctarc.2020.100200