-
BJS Open Nov 2021Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without lymph node removal and preservation of the rectum) and extensive resection (procedures with rectum and pararectal lymph node removal). The aim of this systematic review and meta-analysis was to compare the survival of patients who underwent extensive resection with that of patients who underwent local excision, stratifying patients according to tumour stage.
METHODS
A literature review was performed according to PRISMA guidelines by searching MEDLINE/PubMed for manuscripts published until March 2021. Studies comparing survival outcomes in patients with anorectal melanoma who underwent local excision versus extensive resection were screened for eligibility. Meta-analysis was performed for overall survival after the different surgical approaches, stratified by tumour stage.
RESULTS
There were 347 studiesidentified of which 34 were included for meta-analysis with a total of 1858 patients. There was no significant difference in overall survival between the surgical approaches in patients per stage (stage I odds ratio 1.30 (95 per cent c.i. 0.62 to 2.72, P = 0.49); stage II odds ratio 1.61 (95 per cent c.i. 0.62 to 4.18, P = 0.33); stage I-III odds ratio 1.19 (95 per cent c.i. 0.83 to 1.70, P = 0.35). Subgroup analyses were conducted for the time intervals (<2000, 2001-2010 and 2011-2021) and for continent of study origin. Subgroup analysis for time interval and continent of origin also showed no statistically significant differences in overall survival.
CONCLUSION
No significant survival benefit exists for patients with anorectal melanoma treated with local excision or extensive resection, independent of tumour stage.
Topics: Anus Neoplasms; Humans; Melanoma; Neoplasm Recurrence, Local; Rectal Neoplasms; Retrospective Studies
PubMed: 34958352
DOI: 10.1093/bjsopen/zrab107 -
Annals of Palliative Medicine Nov 2021Diabetic nephropathy (DN) is a secondary disease of diabetes and could cause serious renal damage. This article aimed to investigate the effect of statins on the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetic nephropathy (DN) is a secondary disease of diabetes and could cause serious renal damage. This article aimed to investigate the effect of statins on the treatment of early DN.
METHODS
The databases were searched: Embase (January 2000-August 2021), PubMed (January 2000-August 2021), Cochrane [randomized controlled trial (RCT) database], Ovid (January 2000-August 2021), and clinicaltrials.gov (January 2000-August 2021) to obtain RCT literature related to statin intervention and DN. After screening, the risk of bias assessment was performed using the RevMan 5.4 software bias assessment tool, which was then used to perform the meta-analysis and obtain the therapeutic effects of statins by estimating indicators such as estimated glomerular filtration rate (eGFR), serum creatinine (SCR), total cholesterol (TC) level, total triglyceride (TG), and high-sensitivity C-reactive protein (hs-CRP).
RESULTS
A total of 9 articles, 3,426 patients, and 5 types of statins were included. Meta-analysis showed that after treatment, eGFR in the experimental group was higher than in the control group [mean difference (MD) =5.80; 95% confidence interval (CI): (2.21, 9.40); P=0.002], SCR was lower than in the control group [MD =-0.46; 95% CI: (-0.69, -0.24); P<0.0001], hs-CRP level was lower than in the control group [MD =-1.20; 95% CI: (-2.05, -0.36); P=0.005], TC level was lower than in the control group [MD =-54.09; 95% CI: (-68.02, -40.16); P<0.00001], and TG level was lower than that in the control group [MD =-42.19; 95% CI: (-55.54, -28.84); P<0.00001].
DISCUSSION
Statins can significantly increase eGFR, reduce SCR, decrease CRP level, and decrease blood lipid level in the treatment of DN, thus reducing the inflammatory response and protecting the kidney.
Topics: C-Reactive Protein; Diabetes Mellitus; Diabetic Nephropathies; Glomerular Filtration Rate; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Randomized Controlled Trials as Topic
PubMed: 34872280
DOI: 10.21037/apm-21-2673 -
Cancer Epidemiology Feb 2022Advances in HIV treatments have resulted in life expectancies among people with HIV (PWH) that are similar to people without HIV (non-PWH), provided that PWH have access... (Meta-Analysis)
Meta-Analysis Review
Advances in HIV treatments have resulted in life expectancies among people with HIV (PWH) that are similar to people without HIV (non-PWH), provided that PWH have access to these treatments. As a result of increased survival times, diagnosis of non-AIDS-defining cancers, including anal cancer (AC), has increased among PWH. The purpose of this meta-analysis was to determine if PWH have a higher hazard of mortality compared to non-PWH following AC diagnosis in the post-highly active antiretroviral therapy (HAART) era. We searched PubMed, Embase, Web of Science, and conference abstracts from Jan 1, 1996 - October 31, 2018. Our analysis included longitudinal studies of adults diagnosed with AC which measured a hazard ratio (HR) of overall or cancer-specific mortality comparing PWH versus non-PWH. Using a random-effects model, we estimated the primary outcome, pooled overall survival HR, and the secondary outcome, cancer-specific survival HR. Study quality was assessed using the Newcastle-Ottawa Scale. Thirteen studies were relevant for inclusion, twelve of which had a low risk of bias. Meta-analysis of the studies reporting an overall survival HR found a non-significant pooled HR of 1.11 (95% CI: 0.85-1.44). Meta-analysis of the six studies reporting cancer-specific survival HR found a non-significant pooled HR of 1.15 (95% CI: 0.69-1.93). Heterogeneity was low and medium, respectively. Overall survival and cancer-specific survival HRs indicate that although PWH had higher mortality than non-PWH, the effects were not statistically significant. There is therefore no significant overall survival nor cancer-specific survival differences between PWH and non-PWH in the era of modern treatment.
Topics: Adult; Antiretroviral Therapy, Highly Active; Anus Neoplasms; HIV Infections; Humans
PubMed: 34864578
DOI: 10.1016/j.canep.2021.102069 -
Expert Review of Vaccines Feb 2022Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV)...
INTRODUCTION
Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies.
AREAS COVERED
We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis.
EXPERT OPINION
The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
Topics: Condylomata Acuminata; Female; Humans; Information Storage and Retrieval; Male; Papillomavirus Infections; Papillomavirus Vaccines; Uterine Cervical Neoplasms; Vaccination
PubMed: 34845951
DOI: 10.1080/14760584.2022.2008243 -
Journal of Gastrointestinal Cancer Dec 2022This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. (Review)
Review
PURPOSE
This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum.
METHODS
We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020.
RESULTS
A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2).
CONCLUSION
Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.
Topics: Female; Humans; Male; Middle Aged; Anus Neoplasms; Buschke-Lowenstein Tumor; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Condylomata Acuminata
PubMed: 34694593
DOI: 10.1007/s12029-021-00713-y -
Annals of Palliative Medicine Sep 2021Surgery is the clinically preferred treatment for high perianal abscesses. Incision and seton drainage improve the cure rate and reduce recurrence. We aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery is the clinically preferred treatment for high perianal abscesses. Incision and seton drainage improve the cure rate and reduce recurrence. We aimed to systematically evaluate the clinical effect and safety of incision and seton drainage in the treatment of high perianal abscess.
METHODS
China Knowledge Network (CNKI), WanFang database, VIP database, PubMed, and Cochrane Library were searched and all relevant Chinese and English language documents until July 2021were retrieved. All records that described randomized clinical trials (RCTs) of incision and seton drainage for the treatment of high perianal abscess were eligible. Documents that met the inclusion criteria were evaluated for bias using the Cochrane Collaboration Risk Evaluation Standard, and Revman5.4 software was used to analyze the data.
RESULTS
Fourteen RCTs were included. The results of nine studies showed that the clinical cure rate of the incision-seton group was higher than that of the incision-drainage group (P<0.05). Seven studies showed that the wound healing time of the incision-seton group was shorter than that of the incision-drainage group (P<0.05). Four studies showed that the visual analogue scale (VAS) score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Five studies showed that the Wexner score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Six studies demonstrated that the recurrence rate of abscess in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Seven studies showed that the incidence of adverse events in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Five studies demonstrated that the length of stay in the incision-seton group was shorter than that of the incision-drainage group (P<0.05).
DISCUSSION
The choice of surgical methods in clinical research has always been controversial. The incision-seton method can effectively and safely treat high perianal abscess. However, the results of this meta-analysis still leave some gaps in the evidence. More large-sample, high-quality, and multi-center RCTs are needed.
Topics: Abscess; Anus Diseases; Drainage; Humans; Rectal Fistula; Recurrence
PubMed: 34628909
DOI: 10.21037/apm-21-2229 -
International Journal of Colorectal... Jan 2022Anal fissure is a common condition that can be treated medically or surgically. Chemical sphincterotomy is often used before surgical intervention. This study aims to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anal fissure is a common condition that can be treated medically or surgically. Chemical sphincterotomy is often used before surgical intervention. This study aims to evaluate the effectiveness of topical agents for chemical sphincterotomy on healing of anal fissures and side-effects.
METHODS
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant systematic review was performed using MEDLINE, EMBASE, Scopus, and CENTRAL databases. Eligible studies included randomized controlled trials which compared topical sphincterotomy agents with topical placebo agents or each other. Studies that included surgical treatments were excluded. Overall evidence was synthesized according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
RESULTS
Thirty-seven studies met the study selection criteria. Seventeen studies show that glyceryl trinitrate (GTN) was significantly more likely to heal anal fissure than placebo (relative risk (RR) = 1.96, 95% confidence interval (95%CI) = 1.35-2.84, I2 = 80%). Eleven studies showed a marginally significant difference between healing rates for diltiazem vs GTN, RR = 1.16, (1.01-1.33) I2 = 48%. There was no significant difference in healing between diltiazem and placebo, RR = 1.65, (0.64-4.23), I2 = 92%. GTN significantly reduced pain on the visual analog scale compared to the placebo group, MD-0.97 (-1.64 to -0.29) I2 = 92%. There was high certainty of evidence that GTN was significantly more likely to cause headache than placebo (RR = 2.73 (1.82-4.10) I2 = 58%) and diltiazem RR = 6.88 (2.19-21.63) I2 = 17%.
CONCLUSION
There is low certainty evidence topical nitrates are an effective treatment for anal fissure healing and pain reduction compared to placebo. Despite widespread use of topical diltiazem, more evidence is required to establish the effectiveness of calcium channel blockers compared to placebo.
Topics: Administration, Topical; Chronic Disease; Diltiazem; Fissure in Ano; Humans; Nitroglycerin; Sphincterotomy; Treatment Outcome; Vasodilator Agents
PubMed: 34608561
DOI: 10.1007/s00384-021-04040-3 -
Updates in Surgery Dec 2021Anal Squamous Cell Carcinoma (ASCC) is an uncommon cancer with a recognised precursor Anal Intraepithelial Neoplasia (AIN). Although there are consistent evidence-based... (Review)
Review
Anal Squamous Cell Carcinoma (ASCC) is an uncommon cancer with a recognised precursor Anal Intraepithelial Neoplasia (AIN). Although there are consistent evidence-based guidelines for the management of ASCC, historically this has not been the case for AIN and as a result there have been geographical variations in the recommendations for the treatment of AIN. More recently there have been updates in the literature to the recommendations for the management of AIN. To assess whether we are now closer to achieving an international consensus, we have completed a systematic scoping review of available guidelines for the screening, treatment and follow-up of AIN as a precursor to ASCC. MEDLINE and EMBASE were systematically searched for available clinical guidelines endorsed by a recognised clinical society that included recommendations on either the screening, treatment or follow-up of AIN. Nine clinical guidelines from three geographical areas were included. The most recent guidelines agreed that screening for AIN in high-risk patients and follow-up after treatment was necessary but there was less consensus on the modality of screening. Six Guidelines recommended the treatment of high-grade AIN and four guidelines describe a follow-up protocol of patients diagnosed with AIN. There appears to be increasing consensus on the treatment and follow-up of patients despite a poor evidence base. There is still significant discrepancy in guidance on the method to identify patients at risk of ASCC and AIN despite consensus between geographical regions on which patient subgroups are at the highest risk.
Topics: Anus Neoplasms; Carcinoma in Situ; Carcinoma, Squamous Cell; Consensus; Humans; Mass Screening
PubMed: 34482519
DOI: 10.1007/s13304-021-01156-7 -
International Journal of Colorectal... Nov 2021This study was designed to summarize the current evidence regarding the role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure... (Review)
Review
PURPOSE
This study was designed to summarize the current evidence regarding the role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure (CAF).
METHODS
The present systematic review of the literature was conducted on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint of our study was the CAF recurrence rate. Quality assessment was based on the RoB 2 tool and the Case Series Quality Checklist.
RESULTS
Overall, 5 studies and 102 patients were included. A considerably heterogeneity in the neuromodulation technique and setting was identified. The pooled recurrence rate was estimated at the level of 19% (16/84). Post-interventional pain and Wexner scores were considerably reduced. The 2-month healing rate was 72% (18/25), whereas 73.6% of patients were symptom-free at 6 months.
CONCLUSIONS
PTNS is an effective alternative for the non-operative management of CAF. Due to several limitations further larger and higher quality studies are required.
Topics: Fecal Incontinence; Fissure in Ano; Humans; Quality of Life; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Treatment Outcome
PubMed: 34132862
DOI: 10.1007/s00384-021-03976-w -
Asian Pacific Journal of Cancer... May 2021The term ''Human Papillomavirus'' or ''HPV'' has become synonymous with uterine cervical cancer leading to feminisation of all the preventive measures, especially... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The term ''Human Papillomavirus'' or ''HPV'' has become synonymous with uterine cervical cancer leading to feminisation of all the preventive measures, especially immunisation. Taking into consideration the rising number of HPV associated cancers among men in many developed countries and the risk of transmission to women, male HPV infection is a serious concern. A systematic review and meta-analysis of literature was performed to determine the global prevalence of HPV among men with oropharyngeal and anogenital cancers.
METHODS
A systematic review and meta-analysis of literature was performed searching electronic databases for published articles in English between January 1984- April 2020 based on standard systematic review guidelines. The meta-analysis component was modified appropriately for the synthesis of prevalence study results. National Institutes of Health checklist for observational, cohort and cross-sectional studies was used to assess the quality of the studies selected after the abstract and content review. The meta-analysis was performed in STATA version 13.0 (College Station, Texas 77,845 USA) and the forest plots were constructed using metan package in STATA.
RESULTS
Through the electronic search of databases, 3486 original articles were screened for eligibility. Fifty-eight articles were systematically reviewed and 42 articles were qualified for meta-analysis including 4,250 men with oropharyngeal, penile and prostate cancers. The pooled prevalence of HPV DNA in oropharyngeal cancers was 45% (95%CI 24.0%-66.0%). Meanwhile the pooled prevalence rates of 48% (CI 40.0%- 57.0%) and 19% (CI 10.0%-29.0%) were observed in penile and prostate cancers respectively. Even though, articles regarding HPV prevalence in anal cancers were systematically reviewed, none of the studies were qualified for meta-analysis.
CONCLUSION
Higher pooled prevalence of HPV DNA was observed among men with oropharyngeal and penile cancers. Multicentric molecular studies investigating the prevalence of HPV in prostate cancers have to be planned in future.
Topics: Alphapapillomavirus; Anus Neoplasms; DNA, Viral; Genital Neoplasms, Male; Humans; Male; Oropharyngeal Neoplasms; Papillomavirus Infections
PubMed: 34048162
DOI: 10.31557/APJCP.2021.22.5.1351