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Medicine Jun 2020Glioma-associated oncogene homolog 1(GLI1) expression correlates with the clinical significance and prognosis of several cancers. However, the evaluation of the role... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Glioma-associated oncogene homolog 1(GLI1) expression correlates with the clinical significance and prognosis of several cancers. However, the evaluation of the role GLI1 expression plays in pancreatic ductal adenocarcinoma (PDAC) clinicopathological features and outcomes still lacks.
OBJECTIVE
The present study systemic reviewed the association of GLI1 expression and clinical significance as well as patients survival in PDAC.
METHODS
We systematically searched the database of The Cochrane Library, PubMed, Embase, CNKI, Weipu data, and Wanfang data according to the inclusion and exclusion criteria. (The search ended on January 1, 2019; no language restrictions). The Newcastle-Ottawa Scale (NOS) scale was implemented to assess the quality of the literature and the Review Manager 5.3 Software was used to conduct a meta-analysis. Finally, 9 studies, a total of 1058 patients, have been included.
RESULTS
GLI1 is more likely expressed in PDAC tissue rather than para-carcinoma tissue (OR = 2.86, 95%CI = 1.87-4.36, P < .00001). GLI1 expression is associated with the TNM stage (OR = 3.11, 95%CI = 2.01-4.79, P < .00001), perineural invasion (OR = 2.50, 95%CI = 1.28-4.91, P = .008), and lymphatic metastasis (OR = 2.73, 95%CI = 1.71-4.36, P < .0001). But the association with differentiation (OR = 1.20, 95%CI = 0.74-1.96, P = .46) and tumor size (OR = 2.41, 95%CI = 0.97-6.00, P = .06) was not significant. GLI1 expression is related to the worse overall survival in PDACs (HR = 1.68, 95%CI = 1.40-2.02, P < .00001).
CONCLUSION
Positive GLI1 expression promotes the progression and metastasis of PDACs and plays an important role in the clinical significance and the patients survival.
Topics: Adenocarcinoma; Biomarkers, Tumor; Carcinoma, Pancreatic Ductal; Humans; Prognosis; Zinc Finger Protein GLI1
PubMed: 32590806
DOI: 10.1097/MD.0000000000020950 -
Asian Journal of Surgery Dec 2020Ampullary cancer is a relatively rare gastrointestinal malignancy. The purpose of this study was to evaluate prognostic factors for survival and assess the benefits of... (Meta-Analysis)
Meta-Analysis
Ampullary cancer is a relatively rare gastrointestinal malignancy. The purpose of this study was to evaluate prognostic factors for survival and assess the benefits of adjuvant therapy following pancreaticoduodenectomy for this entity. Medline and EMBASE databases were searched to identify eligible studies from January 2000 to August 2019. Review Manager 5.3 statistical software was used for meta-analysis. 71 studies met the inclusion criteria and were included in the analysis for a total of 8280 patients. The median (range) 5-year overall survival and disease-free survival rates were 58% (32-82%) and 51% (28-73%) respectively. In meta-analysis, age >65 years at diagnosis, tumor size >20 mm, poor differentiation, pancreaticobiliary histotype, pT3-4 stage disease, presence of metastatic lymph node, number of metastatic nodes, perineural invasion, lymphovascular invasion, vascular invasion, pancreatic invasion, and positive surgical margins were independently associated with worse overall survival, whereas adjuvant therapy was associated with improved overall survival. In summary, in patients with ampullary cancer undergoing pancreaticoduodenectomy, tumor factors are the main predictors of worse survival and adjuvant treatment confers a survival benefit.
Topics: Aged; Aged, 80 and over; Ampulla of Vater; Chemotherapy, Adjuvant; Common Bile Duct Neoplasms; Duodenal Neoplasms; Female; Humans; Male; Neoplasm Invasiveness; Neoplasm Metastasis; Pancreatic Neoplasms; Pancreaticoduodenectomy; Prognosis; Survival Rate
PubMed: 32249101
DOI: 10.1016/j.asjsur.2020.03.007 -
The Chinese Journal of Dental Research 2020Salivary adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) are the most common types of salivary gland tumours; the former is malignant and the latter is...
Salivary adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) are the most common types of salivary gland tumours; the former is malignant and the latter is benign but with features of a border tumour. Proteoglycans (PGs) produced by neoplastic myoepithelial cells are ubiquitous in both types of tumours. However, normal myoepithelial cells of salivary glands do not have the ability to secrete PGs. When the synthesis of PGs is blocked, the pulmonary metastasis and perineural growth of salivary ACC as well as the implanting growth of salivary PA are inhibited, highlighting the important functions of PGs in the tumourigenesis and development of these two tumours. In this review, we summarise literature from the past 40 years, including more recent findings from our laboratory, to clarify the pivotal roles of PGs produced by neoplastic myoepithelial cells in both the histogenesis and biological behaviours of ACC and PA.
Topics: Adenoma, Pleomorphic; Carcinogenesis; Carcinoma, Adenoid Cystic; Humans; Proteoglycans; Salivary Glands
PubMed: 32232225
DOI: 10.3290/j.cjdr.a44332 -
Endocrine Jan 2020There are no clear histopathological parameters determining the risk of lymph node (LN) metastases and appropriateness of completion prophylactic right hemicolectomy... (Meta-Analysis)
Meta-Analysis
The risk of lymph node metastases and their impact on survival in patients with appendiceal neuroendocrine neoplasms: a systematic review and meta-analysis of adult and paediatric patients.
BACKGROUND
There are no clear histopathological parameters determining the risk of lymph node (LN) metastases and appropriateness of completion prophylactic right hemicolectomy (RHC) in patients with appendiceal neuroendocrine neoplasms (ANENs).
MATERIALS AND METHODS
The PubMed, Cochrane Library, Embase, Web of Science and SCOPUS databases were searched up to November 2018. Quality/risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).
RESULTS
A total of 526 articles were screened. In 11 adult and 3 paediatric studies, 602 and 77 unique patients, respectively, with ANEN and undergoing RHC, were included. The rate of LN metastases for a cutoff size >10 mm was 48.6% (vs 12.1% for lesions <10 mm) among adult patients, with an odds ratio (OR) of 4.8 (95% CI, 1.5-15.8). For 20 mm size cutoff, these figures were 61% (vs 28.2% for lesions <20 mm) with an OR of 3.2 (95% CI, 1.3-7.8). Vascular-, lymph vessel- and perineural invasions were identified as predictive factors for LN metastases in adult patients. In paediatric patients, there were no strong morphological predictors for LN metastases. The 10-year disease-specific survival (DSS) for adult patients without LN metastases was 99.2% vs 95.6% in patients with LN (OR: 0.2; 95% CI, 0.02-2.4). The complication rate of prophylactic RHC was 11.4%.
CONCLUSIONS
This meta-analysis demonstrates that tumour size >20 mm as well as >10 mm and/or vascular-, lymph vessel- and perineural invasions are associated with increased risk for LN metastases in adult patients with ANEN. The prognostic value of LN positivity remains to be determined in further studies with long-term follow-up.
Topics: Adult; Appendiceal Neoplasms; Child; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neuroendocrine Tumors; Prognosis; Retrospective Studies
PubMed: 31493274
DOI: 10.1007/s12020-019-02072-y -
Anaesthesia Oct 2019Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop...
Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol, cyclo-oxygenase-2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre-operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α-2-adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra-articular injection, and for surgical technique-linked interventions, such as platelet-rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non-steroidal anti-inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.
Topics: Guidelines as Topic; Humans; Orthopedic Procedures; Pain Management; Pain, Postoperative; Randomized Controlled Trials as Topic; Rotator Cuff
PubMed: 31392721
DOI: 10.1111/anae.14796 -
Orthopaedics & Traumatology, Surgery &... Sep 2019Indications for revision surgery are unclear in refractory cubital tunnel syndrome patients, and the optimal surgical method has not been determined. The systematic...
BACKGROUND
Indications for revision surgery are unclear in refractory cubital tunnel syndrome patients, and the optimal surgical method has not been determined. The systematic review evaluates the evidence of functional outcome for revision surgery in refractory cubital tunnel syndrome patients.
HYPOTHESIS
We hypothesize that functional outcome of revision surgery in refractory cubital tunnel syndrome will be favorable.
METHODS
We searched PubMed, Ovid/MEDLINE, Cochrane, Google Scholar, and EMBASE databases using the keywords "cubital tunnel syndrome" or "recurrent cubital tunnel syndrome" and "revision surgery" according to the MeSH index for English-language studies. We performed a systematic review using PRISMA guidelines. The review was registered in PROSPERO (CRD42018096622).
RESULTS
Based on the Oxford Centre for Evidence-Based Medicine criteria, one level 3b study and nine level 4 studies were identified, including 195 elbows of 192 patients aged 15-75 years. The remission period for recurrent cubital tunnel syndrome was 6-21 months, and the follow-up period was 6-113 months. Transposition surgery was the primary surgery in 99 (51%) of 178 elbows. The most common intraoperative finding at revision surgery was perineural scarring (79%), with the most frequent entrapment site being the medial intermuscular septum (33%). The most common revision surgery was submuscular transposition of the ulnar nerve (75%). Most studies reported favorable outcomes, although outcomes varied widely among studies.
CONCLUSION
This is the first study to summarize the functional outcomes of revision surgery for refractory cubital tunnel syndrome which showed to be favorable. Functional outcomes were averagely reported and varied widely. A consensus regarding the functional outcomes parameter after surgery for cubital tunnel syndrome is urgently needed.
LEVEL OF EVIDENCE
III, systematic review.
Topics: Cubital Tunnel Syndrome; Decompression, Surgical; Elbow Joint; Humans; Reoperation; Ulnar Nerve
PubMed: 31331798
DOI: 10.1016/j.otsr.2019.03.020 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Apr 2019Salivary adenoid cystic carcinoma (SACC) is a common malignant tumor in the oral and maxillofacial region and accounts for approximately 3%-5% of all head and neck...
Salivary adenoid cystic carcinoma (SACC) is a common malignant tumor in the oral and maxillofacial region and accounts for approximately 3%-5% of all head and neck carcinomas. SACC always occurs in the palatal salivary gland and parotid gland. The tumor has the characteristics of strong invasion, perineural invasion, high hematogenous metastasis, and low lymph node metastasis rate. The biological characteristics of SACC determine the specificity of clinical treatment. Thus far, few clinical trials have investigated the efficacy of systemic therapy owing to the rarity of SACC with lung metastasis. Moreover, long-term results are poor, and no consensus on standard treatment has been reached yet. This systematic review aims to provide a retrospective analysis of treatment options and prognosis for SACC with lung metastasis and evidence for future clinical treatment.
Topics: Carcinoma, Adenoid Cystic; Cell Line, Tumor; Humans; Neoplasm Invasiveness; Prognosis; Retrospective Studies; Salivary Gland Neoplasms
PubMed: 31168990
DOI: 10.7518/hxkq.2019.02.015 -
The Clinical Journal of Pain Apr 2019The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery. (Review)
Review Meta-Analysis
OBJECTIVES
The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery.
METHODS
Electronic databases, including PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library, were conducted to collect the randomized controlled trials (RCTs) from inception to March 2018. RCTs investigating the impact of adding DEX to local anesthetics for TAP blocks were included in this analysis. Pain scores (at rest and movement), opioid consumption, the duration of the TAP block and the common adverse effects were analyzed.
RESULTS
Twenty published trials including 1212 patients met the inclusion criteria. The addition of DEX significantly reduced pain scores 8 hours postoperatively at rest (WMD, -0.78; 95% CI, -1.27 to -0.30; P=0.001), 4 hours postoperatively on movement (WMD, -1.13; 95% CI, -1.65 to -0.60; P<0.001), and opioid consumption (WMD, -13.71; 95% CI, -17.83 to -9.60; P<0.001) when compared with control group. Furthermore, perineural DEX significantly prolonged the duration of the TAP block (WMD, 3.33; 95% CI, 2.85 to 3.82; P<0.001). It did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, somnolence, or pruritus.
CONCLUSIONS
DEX is a potential anesthetic adjuvant that can facilitate better postoperative analgesia, reduce postoperative analgesic requirements, and prolong the local anesthetic effect when administered in TAP blocks.
Topics: Abdominal Muscles; Adjuvants, Anesthesia; Anesthetics, Local; Dexmedetomidine; Humans; Nerve Block
PubMed: 30475260
DOI: 10.1097/AJP.0000000000000671 -
BMC Cancer Oct 2018The impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and meta-analysis was performed to evaluate this issue.
METHODS
Relevant studies published from January 2000 to June 2017 were identified through EMBASE and PUBMED. Data were pooled for meta-analysis using Review Manager 5.3.
RESULTS
Twenty eight observational studies involving a total of 23,945 patients were included. Tumors > 2 cm was associated with poor prognosis: the pooled hazard ratio (HR) estimate for overall survival was 1.52 (95% confidence interval [CI]: 1.41-1.64; P < 0.0001) by univariate analysis and 1.61 (95% CI: 1.35-1.91; P < 0.0001) by multivariate analysis; the pooled HR estimate for disease-free survival was 1.74 (95% CI: 1.46-2.07; P < 0.0001) by univariate analysis and 1.38 (95% CI: 1.12-1.68; P = 0.002) by multivariate analysis. When compared with patients with tumors ≤2 cm, those with the tumors > 2 cm had higher incidences of lymph node metastasis, poor tumor differentiation, lymph vessel invasion, vascular invasion, perineural invasion, and positive intraoperative peritoneal cytology.
CONCLUSION
These data demonstrate that PDAC size > 2 cm is an independent predictive factor for poor prognosis after surgical resection and associated with more aggressive tumor biology.
Topics: Adenocarcinoma; Carcinoma, Pancreatic Ductal; Disease-Free Survival; Humans; Observational Studies as Topic; Pancreatic Neoplasms; Predictive Value of Tests; Prognosis
PubMed: 30326871
DOI: 10.1186/s12885-018-4901-9 -
Clinical Otolaryngology : Official... Mar 2019The decision whether to include postoperative radiotherapy on patients with oral squamous cell carcinoma depends on the risk of local recurrence. The objectives of this...
OBJECTIVES OF THE REVIEW
The decision whether to include postoperative radiotherapy on patients with oral squamous cell carcinoma depends on the risk of local recurrence. The objectives of this study were to systematically review literature on whether perineural invasion in oral squamous cell carcinoma patients is associated with higher local recurrence rates and whether local recurrence is influenced by the administration of postoperative radiotherapy in patients presenting with perineural invasion.
TYPE OF REVIEW
Systematic review.
SEARCH STRATEGY
Embase, PubMed, Web Of Science.
EVALUATION METHOD
The databases above were searched for studies that analysed: the treatment of oral squamous cell carcinoma patients with perineural invasion, local recurrence and postoperative radiotherapy. The data of seven studies were analysed qualitatively.
RESULTS
The overall quality of the studies was moderate to low. There was no evidence of the effect of postoperative radiotherapy on local recurrence rates in patients presenting with perineural invasion. Some evidence suggests that local recurrence rates may increase in cases of multifocal perineural invasion, especially if nerves >1 mm are involved but these data should be interpreted with caution due to the low-quality evidence.
CONCLUSIONS
High-quality evidence regarding the prognostic value of perineural invasion and the impact of postoperative radiotherapy in patients presenting with perineural invasion is lacking in the literature, making it difficult to select a postoperative strategy for early-stage tumours.
Topics: Carcinoma, Squamous Cell; Humans; Mouth Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant
PubMed: 30295408
DOI: 10.1111/coa.13239