Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis

IntroductionMany national guidelines concerning the management of ovarian cancer currently advocate the risk of malignancy index (RMI) to characterise ovarian pathology. However, other methods, such as subjective assessment, International Ovarian Tumour Analysis (IOTA) simple ultrasound-based rules (simple rules) and IOTA logistic regression model 2 (LR2) seem to be superior to the RMI.Our objective was to compare the diagnostic accuracy of subjective assessment, simple rules, LR2 and RMI for differentiating benign from malignant adnexal masses prior to surgery.Materials and methodsMEDLINE, EMBASE and CENTRAL were searched (January 1990–August 2015). Eligibility criteria were prospective diagnostic studies designed to preoperatively predict ovarian cancer in women with an adnexal mass.ResultsWe analysed 47 articles, enrolling 19,674 adnexal tumours; 13,953 (70.9%) benign and 5721 (29.1%) malignant. Subjective assessment by experts performed best with a pooled sensitivity of 0.93 (95% confidence interval [CI] 0.92–0.95) and specificity of 0.89 (95% CI 0.86–0.92). Simple rules (classifying inconclusives as malignant) (sensitivity 0.93 [95% CI 0.91–0.95] and specificity 0.80 [95% CI 0.77–0.82]) and LR2 (sensitivity 0.93 [95% CI 0.89–0.95] and specificity 0.84 [95% CI 0.78–0.89]) outperformed RMI (sensitivity 0.75 [95% CI 0.72–0.79], specificity 0.92 [95% CI 0.88–0.94]). A two-step strategy using simple rules, when inconclusive added by subjective assessment, matched test performance of subjective assessment by expert examiners (sensitivity 0.91 [95% CI 0.89–0.93] and specificity 0.91 [95% CI 0.87–0.94]).ConclusionsA two-step strategy of simple rules with subjective assessment for inconclusive tumours yielded best results and matched test performance of expert ultrasound examiners. The LR2 model can be used as an alternative if an expert is not available.     

Race in ovarian cancer treatment and survival: a systematic review with meta-analysis

Objective  There has long been recognition of racial disparities in cancer treatment and survival. In order to investigate the etiology of racial disparities in ovarian cancer, we undertook a systematic review of the published literature. Methods  Focusing on North America, our search of MEDLINE, PsychInfo, and EMBASE databases recovered 513 abstracts of which 98 underwent full text screening resulting in 24 studies included in the final review. After assessing heterogeneity, results were pooled where possible in a meta-analysis using a random effects model. Results  Eight articles reported treatment outcomes, nine survival, and seven both. Overall African Americans were less likely to receive any form of surgical treatment for ovarian cancer [pooled relative risk (RR) 1.17 (95% confidence interval (CI): 1.10, 1.23)] compared with white women. Although the majority of the included articles reporting survival outcomes did not control for known covariates such as medical co-morbidities or treatment, we were able to pool the unadjusted results from eight articles. Taken together the meta-analysis of 106,704 women did not find a difference in five-year survival between whites and African Americans, RR 1.07 (95% CI: 0.97, 1.18). When the results were stratified by year of cancer diagnosis, studies which captured patients prior to 1985 yielded a five-year RR of survival for whites compared to African Americans of 0.93 (95% CI: 0.89, 0.97) compared with 1.17 (95% CI: 1.05, 1.31) after 1985. Conclusion  These results suggest that racial disparities in ovarian cancer are not due to underlying biological differences rather to the unequal application of existing treatments. Previous presentation of results  The results from this study were presented at the XVIII IEA World Congress of Epidemiology, September 20–24, 2008 in Porto Alegre, Rio Grande do Sul, Brazil.     

Clinical effectiveness of neoadjuvant chemotherapy in advanced gastric cancer: An updated meta-analysis of randomized controlled trials

Aims

To assess the efficacy and safety of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (AGC).

Methods

By searching electronic databases (PubMed, Embase, Cochrane Library) and ASCO proceedings from 1990 to 2012, all randomized controlled trials (RCTs) which compared the effect of NAC-combined surgery versus surgery alone in AGC were included. All calculations and statistical tests were performed using RevMan 5.0 software.

Results

12 RCTs with a total of 1820 patients were included. All patients had locally advanced but resectable gastric cancer and received NAC. NAC can slightly improve the survival rate (OR = 1.32, 95% confidence interval (CI): 1.07–1.64, P = 0.01), with little or no significant benefits in subgroup analyses between either different population or regimens. NAC can significantly improve the 3-year progression-free survival (PFS) (OR: 1.85, 95% CI: 1.39–2.46, p < 0.0001), tumor down-staging rate (OR: 1.71, 95% CI: 1.26, 2.33, p = 0.0006) and R0 resection rate (OR: 1.38, 95% CI: 1.08–1.78, P = 0.01) of patients with AGC. There was no difference between the two arms, in terms of relapse rates (OR: 1.03, 95% CI: 0.60–1.78, p = 0.92), operative complications (OR: 1.20, 95% CI: 0.90–1.58, p = 0.21), perioperative mortality (OR: 1.14, 95% CI: 0.64–2.05, p = 0.65) and grade 3/4 adverse effects: gastrointestinal problem (OR: 0.57, 95% CI: 0.25–1.30, p = 0.18), leukopenia (OR: 0.88, 95% CI: 0.41–1.91, p = 0.75), thrombocytopenia (OR: 1.27, 95% CI: 0.27–5.93, p = 0.76).

Conclusion

NAC is effective and safe. However, further prospective multi-national and multi-center RCTs are still needed in order to investigate the long-term oncological and functional outcomes to define the clinical benefits of NAC and the most effective strategies for AGC.     

Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: A systematic review and meta-analysis

BackgroundAdministration of chemotherapy before breast surgery has the potential to reduce the risk of distant recurrence by targeting micrometastasis as well as allowing a more minimalistic approach to surgical intervention. We performed a systematic review to determine the optimum timing of surgery post breast cancer neoadjuvant chemotherapy (NACT).MethodsThe primary outcome was to determine whether the timing of surgery post NACT impacted overall survival (OS) and disease-free survival (DFS). We compared patient outcomes between those who had surgery within 8 weeks of completion of NACT to those that had surgery after 8 weeks. An outcome comparison between <4 weeks and 4–8 weeks was also performed. Secondary outcome included complete pathological response (pCR) post NACT. A meta-analysis was performed using the Mantel-Haenszel method.ResultsFive studies, including 8794 patients were eligible for inclusion. Patients that had surgery within 8 weeks of completion of NACT had a statistically significant improved OS(OR 0.47, 95% c. i 0.34–0.65) and DFS(OR 0.71 (95% c. i 0.52–0.98, P = 0.04). There were no survival advantages associated with having surgery less than 4 weeks post completion of NACT (OR 0.78, 95% c. i 0.46–1.33, P = 0.37). There was no difference in pCR rate between those that had surgery <4 weeks and 4–8 weeks (OR 1.01, 95% c. i 0.80–1.28, P = 0.93).ConclusionThis meta-analysis shows that the optimum timing of surgery post completion of NACT is 4–8 weeks as it is associated with increased OS and DFS.     

EFFECT OF NEOADJUVANT CHEMOTHERAPY USING PACLITAXEL COMBINED WITH CARBOPLATIN ON ADVANCED NON-SMALL CELL LUNG CANCER

Objeetive： To assess the therapeutic effectiveness of preoperative neoadjuvant chemotherapy using a combination of paclitaxel and carboplatin on local advanced non-small cell lung cancer （NSCLC）. Methods： Twenty-five patients with advanced NSCLC were treated with paclitaxel and carboplatin for 2 to 4 cycles before undergoing tumor resection and then postoperative chemotherapy/radiotherapy therapy for 2 to 4 cycles. Results： Following neoadjuvant chemotherapy, the most prominent side-effect was bone marrow restraint. The overall response rate of preoperative chemotherapy was 56%. The mean survival time was 26.5 months, with 1-, 2- and 5-year survival rates of 55%, 25%, and 16%, respectively. All NSCLC patients survived the perioperative period. Conclusion： Preoperative neoadjuvant chemotherapy combining paclitaxel and carboplatin produced minimal side-effect while increasing the probability that advanced NSCLC patients would be able to undergo surgery thus improving their prognosis.     

Multimodal treatments for resectable gastric cancer: A systematic review and network meta-analysis

Different countries prefer particular types of multimodal treatments against resectable gastric cancer. Due to lacking of unified conclusions, we therefore conducted a network meta-analysis to rank all recommended strategies simultaneously and hierarchically. Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, ASCO and ESMO meeting libraries from inception to September 2018. Randomized controlled trials featuring comparisons between different preferred multimodal treatments against resectable gastric cancer were eligible. The Cochrane Risk of Bias Tool was applied to assess methodological quality of included trials. Overall survival was primary endpoint. Network calculation was based on random-effects model and the relative ranking of each node was numerically indicated by P-score. All procedures were conducted according to Cochrane Handbook 5.1 and PRISMA for Network Meta-analysis (CRD42018109147). As a result, a total of 11 studies were included into our systematic review, corresponding to 7235 patients. Regarding overall survival, “PeriCT (FLOT)” (perioperative 5-FU plus leucovorin plus oxaliplatin plus docetaxel chemotherapy) topped the hierarchy (HR 1.00, P-score = 0.918), followed by “PostCT (XP)” (postoperative capecitabine plus platinum chemotherapy; HR 1.14, P-score = 0.759) and “PostCT (S-1)” (postoperative S-1 monotherapy; HR 1.16, P-score = 0.732). In subgroup analyses, “PostCT (XP)” became the top regimen for eastern population while “PeriCT (FLOT)” was the optimal node for western population. In conclusion, perioperative FLOT chemotherapy could potentially be the best multimodal treatment against resectable gastric cancer than other recommended strategies. Therefore, a global D2-lymphadenectomy randomized controlled trial comparing perioperative FLOT chemotherapy with postoperative XELOX chemotherapy should be carried out.     

Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases

Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we present two ovarian cancer cases which are clinically diagnosed with port site metastasis during neoadjuvant chemotherapy following diagnostic laparoscopy. Although neoadjuvant chemotherapy is sometimes needed in cases of fully advanced ovarian cancers, port-site metastasis may be encountered during neoadjuvant chemotherapy. The possible poor prognosis of these patients, especially those who have ascites, should make us careful in performing diagnostic laparoscopy with preventive measures for port-site metastasis and to start the chemotherapy immediately.     

Effects of CytoReductive surgery plus hyperthermic IntraPEritoneal chemotherapy (HIPEC) versus CytoReductive surgery for ovarian cancer patients: A systematic review and meta-analysis

BackgroundThe effects of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) and CytoReductive Surgery (CRS) for ovarian cancer patients remain controversial.MethodsA systematic review and meta-analysis was conducted using PubMed, Embase and Web of Science databases to investigate Overall Survival (OS), Disease Free Survival (DFS) and adverse effects between HIPEC and CRS group. Results: In our overall analysis (13 studies), patients in the HIPEC group exhibited a significantly improved OS (HR = 0.56, 95% CI = 0.41–0.76, P < 0.01) and DFS (HR = 0.61, 95% CI = 0.48–0.77, P < 0.01). Subgroup analysis revealed improved OS (HR = 0.57, 95% CI = 0.40–0.83, P = 0.04) and DFS (HR = 0.61, 95% CI = 0.47–0.80, P < 0.01) for primary ovarian cancer in favour of HIPEC group. However, recurrent ovarian cancer patients who received HIPEC exhibited only significantly improved OS (HR = 0.48, 95% CI = 0.24–0.96, P < 0.01) but not DFS (HR = 0.59, 95% CI = 0.33–1.08, P = 0.09). In addition, both significantly improved OS and DFS were also observed in patients who received HIPEC in the subgroups based on the following factors: studies published before 2015, studies with ≥100 total patients, a single drug used for HIPEC, 90-min HIPEC duration and a regimen of CRS plus HIPEC followed by chemotherapy. Moreover systematically reviewed toxicity, morbidity, mortality and long-term outcomes were tolerable after HIPEC.ConclusionsThe addition of HIPEC to CRS could significantly improve OS of ovarian cancer patients, albeit optimal drug regimen is not clear.     

Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

ObjectiveTo evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).MethodsSystematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay.ResultsNine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71–6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67).ConclusionDespite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications.Trial RegistrationPROSPERO Identifier: CRD42022303577     

新辅助化疗对晚期上皮性卵巢癌患者预后的影响

目的 探讨新辅助化疗对Ⅲc～Ⅳ期上皮性卵巢癌患者预后的影响.方法 回顾性分析160例Ⅲc～Ⅳ期上皮性卵巢癌患者的临床病理资料,其中42例患者行新辅助化疗后再行肿瘤细胞减灭术(NAC组),118例患者先行初次肿瘤细胞减灭术(PCS)再行化疗(PCS组),比较两组患者的生存情况及与预后相关的因素.结果新辅助化疗的总有效率为69.1%.在手术时间、术中出血量和输血量等方面,NAC组与PCS组的差异无统计学意义(P＞0.05).NAC组肿瘤细胞减灭术的满意率为88.1%,明显高于PCS组(71.2%,P＜0.05).NAC组和PCS组的复发率分别为43.2%和56.0%,差异无统计学意义(P＞0.05).NAC组的中位无瘤生存时间和中位疾病无进展生存时间分别为7个月和8个月,低于PCS组的13个月和18个月(P＜0.05);但是NAC组和PCS组的中位总生存时间分别为34个月和43个月,差异无统计学意义(P＞0.05).NAC组有37例患者行满意的肿瘤细胞减灭术(OCS),中位总生存时间为34个月;PCS组有84例患者行OCS,中位总生存时间为48个月,两组差异无统计学意义(P＞0.05).结论 新辅助化疗可以提高Ⅲc-Ⅳ期上皮性卵巢癌患者肿瘤细胞减灭术的满意率,但未降低患者治疗后的复发率,也未延长患者的总生存时间.     

Intraperitoneal chemotherapy in the management of pancreatic adenocarcinoma: A systematic review and meta-analysis

BackgroundPancreatic cancer represents one of the leading causes of cancer-related death worldwide. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proven with curative intent mainly for other tumors and there is a lack of consensus regarding possible benefits also in pancreatic cancer. The present systematic review and meta-analysis aim to provide an up-to-date overview of the effectiveness and safety of intraperitoneal treatments in the management of pancreatic cancer.MethodsA systematic review of articles was conducted according to PRISMA and AMSTAR-2 guidelines. 11 studies were included in the analysis.ResultsWe included in our analysis 212 patients subdivided in three groups: 64 in the HIPEC group (57 with prophylactic intent and 7 with curative intent), 55 in the PIPAC group and 93 in the NIPEC group. Primary outcomes were represented by survival rates; we evidenced at an observation time of three years a survival of 24% in the HIPEC group (25.5% in the prophylactic arm and 6.2% in the curative arm), 5.3% in the PIPAC group and 7.9% in the NIPEC group.ConclusionsHIPEC could be considered as a promising technique for prophylaxis and treatment of peritoneal metastasis (PM) in case of borderline resectable and locally advanced disease. Increased survival rates emerged without additional morbidity when surgical resection and CRS are possible. In addition, our data about PIPAC and NIPEC as palliative treatment in unresectable disease seems to identify more favorable survival rates compared to literature.     

Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis

BackgroundThe increased use of neoadjuvant chemotherapy (NACT) facilitates an increase in breast-conserving surgery and immediate breast reconstruction. While NACT is considered to have the same oncological safety as adjuvant chemotherapy, evidence on the impact of NACT on surgical outcomes following breast surgery is unclear and varies across studies. The aim of this systematic review and meta-analysis was to assess the impact of NACT on surgical complications in breast cancer patients undergoing any kind of breast surgery.MethodsDatabase searches were conducted (March 26, 2021) to identify studies assessing the impact of NACT on postoperative complications. Studies were included if they compared a group of patients treated with NACT to a control group that was not, and if they reported at least one of our defined outcomes. Primary effect measures were odds ratios (ORs) and mean difference with a 95% confidence interval. Study quality was assessed by the Newcastle-Ottawa Scale.ResultsTwenty-six studies comprising 134,191 patients were included. NACT was not associated with an increased complication rate for overall complications (OR: 1.13, 95% CI: 0.86 to 1.47, p = 0.38), individual postoperative complications, nor surgery duration. There was a non-significant trend towards NACT increasing the risk of seroma, wound complications, skin or nipple necrosis, flap ischemia or loss, and implant loss. A significant difference in blood loss was found, favouring NACT (MD = ?75.85, 95% CI: -107.47 to ?44.23, p < 0.00001). Heterogeneity was significant between the studies (I²>50%).ConclusionCompared to a control group, NACT was not found to affect the surgical complications adversely.     

Omentectomy vs omentum preservation for advanced gastric cancer: A systematic review and meta-analysis

Currently, gastric cancer is the sixth most prevalent cancer in the world. The recommended treatment for advanced disease is gastrectomy with D2 lymphadenectomy. However, there is no consensus regarding the performance of an omentectomy as part of the treatment. The procedure is considered by some authors to be essential for the elimination of a micrometastasis since cells in the peritoneum prefer growing in milky spots in the omentum. On the other hand, retrospective studies demonstrated that there is the possibility that omentum preservation may not impact patients’ overall survival. Therefore, the objective of this review was to quantify the effect of performing an omentectomy to determine whether it is necessary. Medline (PubMed), Embase, Cochrane, ClinicalTrials.gov and LILACS were searched up to September 2022. Selection was restricted to comparative studies in patients with advanced GC (≥T2). The certainty of evidence was assessed with GRADEPro and the risk of bias with ROBINS-I and RoB 2.0. Five cohort studies, and one randomized controlled trial (RCT) were included. The meta-analysis found that there were no significant differences between the procedures for overall survival, relapse-free survival, and peritoneal recurrence. Furthermore, in perioperative outcomes, a significant difference was only found in intraoperative bleeding, which was lower in patients who had their omentum preserved. Therefore, omentum preservation in patients with advanced gastric cancer has been shown to have no inferior results than resection in long-term outcomes.     

紫杉醇联合卡铂密集方案新辅助治疗三阴性乳腺癌的疗效及远期生存

目的评价PC(紫杉醇+卡铂)密集方案新辅助治疗三阴性乳腺癌的疗效和远期生存, 探索三阴性乳腺癌新辅助化疗的优化方案。方法 2008年1月至2018年9月中国医学科学院肿瘤医院病理确诊为三阴性乳腺癌(临床分期T1～4N0～3M0)、接受PC密集方案新辅助化疗及手术的患者, 采用倾向性评分方法对PC密集方案组和3周方案组患者进行1∶1最近邻匹配, 比较两组的疗效、安全性及远期生存。结果纳入三阴性乳腺癌患者100例, 密集方案组和3周方案组各50例。密集方案组和3周方案组的客观有效率(ORR)均为90.0%(45/50)。密集方案组3～4级中性粒细胞减少的发生率低于3周方案组(分别为32.7%和68.0%, P=0.001), 但肝功能异常的发生率高于3周方案组(分别为57.1%和32.0%, P=0.012)。病理学完全缓解(pCR)率分别为34.0%(17/50)和38.0%(19/50), 差异无统计学意义(P=0.677)。中位随访55个月, 密集方案组和3周方案组的5年无复发生存率分别为83.5%和75.2%, 5年总生存率分别为87.9%和84.5%, 差异均无统计学意义(P值分...     

Survival and toxicity in neoadjuvant chemotherapy plus surgery versus definitive chemoradiotherapy for cervical cancer: A systematic review and meta-analysis

PurposeNeoadjuvant chemotherapy followed by surgery (NACT + S) has been compared with definitive chemoradiothherapy (CRT) in randomized clinical trials (RCTs) in stage IB2, IIA and IIB cervical cancer (1994 Figo stage). Our aim was to evaluate efficacy and toxicity of NACT + S and CRT and identify differences in clinical outcomes and severe toxicity frequency.MethodsThe PRISMA statement was applied. Random-effects models were used.ResultsTwo RCTs representing 1259 patients were identified. NACT + S was not associated with significant OS improvement compared with CRT, with HR of 1.08 (95% CI = 0.86–1.36; p = 0.51). The HR of relapse was 1.32 (95%CI = 1.07–1.62) in favor of CRT. Severe acute toxicity was lower in CRT group.ConclusionThis meta-analysis showed similar OS rates between treatment and CRT superiority over NACT + S in terms of DFS and severe acute toxicity. Impact on long term toxicity and quality of life remain to be proven.     

力朴素与奈达伯联合先期化疗对晚期卵巢上皮性癌的临床观察

目的观察力朴素与奈达伯联合行新辅助化疗对晚期卵巢上皮性癌近期的疗效及毒副反应。方法晚期卵巢上皮性癌80例，采用力朴素与奈达伯联合化疗方案（力朴素135mg／m2，奈达伯80mg／m2-100mg／m2），全身静脉化疗结合腹腔灌注化疗，3周为一个疗程，于术前完成1—2个疗程治疗后，行体检、影像学检查及手术治疗，从而判断治疗疗效及毒副作用。结果治疗有效率为92．5％（74／80）；白细胞下降发生率为50％（40／80），胃肠道反应发生率为77．5％（62／80）；所有患者均未因毒副反应中断或退出治疗。结论力朴素与奈达伯联合行先期化疗对晚期卵巢上皮性癌效果较好，毒副反应较轻。     

Survival after radiotherapy in gastric cancer: Systematic review and meta-analysis

Background and purpose

A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer.

Methods

Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers’ score.

Results

Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08-1.48; NNT = 17) and 1.31 (95% CI: 1.04-1.66; NNT = 13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found.

Conclusion

This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies.     

Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis

Objective

The impact of primary tumor resection (PTR) on survival is still controversial in stage IV breast cancer. This systematic review and meta-analysis aimed to evaluate the impact of PTR on overall survival (OS) in stage IV breast cancer.

Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: A systematic review and meta-analysis

PurposeWe conducted a systematic review and meta-analysis to quantify the pathological complete response (pCR) rate after preoperative (chemo)radiation with doses of ⩾60 Gy in patients with locally advanced rectal cancer. Complete response is relevant since this could select a proportion of patients for which organ-preserving strategies might be possible. Furthermore, we investigated correlations between EQD2 dose and pCR-rate, toxicity or resectability, and additionally between pCR-rate and chemotherapy, boost-approach or surgical-interval.Methods and materialsPubMed, EMBASE and Cochrane libraries were searched with the terms ‘radiotherapy’, ‘boost’ and ‘rectal cancer’ and synonym terms. Studies delivering a preoperative dose of ⩾60 Gy were eligible for inclusion. Original English full texts that allowed intention-to-treat pCR-rate calculation were included. Study variables, including pCR, acute grade ⩾3 toxicity and resectability-rate, were extracted by two authors independently. Eligibility for meta-analysis was assessed by critical appraisal. Heterogeneity and pooled estimates were calculated for all three outcomes. Pearson correlation coefficients were calculated between the variables mentioned earlier.ResultsThe search identified 3377 original articles, of which 18 met our inclusion criteria (1106 patients). Fourteen studies were included for meta-analysis (487 patients treated with ⩾60 Gy). pCR-rate ranged between 0.0% and 44.4%. Toxicity ranged between 1.3% and 43.8% and resectability-rate between 34.0% and 100%. Pooled pCR-rate was 20.4% (95% CI 16.8–24.5%), with low heterogeneity (I² 0.0%, 95% CI 0.00–84.0%). Pooled acute grade ⩾3 toxicity was 10.3% (95% CI 5.4–18.6%) and pooled resectability-rate was 89.5% (95% CI 78.2–95.3%).ConclusionDose escalation above 60 Gy for locally advanced rectal cancer results in high pCR-rates and acceptable early toxicity. This observation needs to be further investigated within larger randomized controlled phase 3 trials in the future.     

Gender susceptibility for cigarette smoking-attributable lung cancer: A systematic review and meta-analysis

Objectives

As the primary cause of lung cancer, whether smoking confers the same risk of lung cancer for women as men is unclear. Therefore, we aimed to compare male and female susceptibility for cigarette smoking-attributable lung cancer.

Methods

A systematic review and meta-analysis was conducted by searching articles published up to July 2013 in three online databases (MEDLINE, EMBASE, and Cochrane Database). All studies estimated the association of cigarette smoking with the risk of lung cancer between men and women, respectively. A random effects model with inverse variance weighting was used to pool data. Male to female ratio of relative risk (RRR) was calculated to compare male and female susceptibility for cigarette smoking-attributable lung cancer.

Results

47 articles containing 404,874 individuals were included in the final analysis. Compared with non-smokers, male to female RRR was 1.61 (95%CI: 1.37, 1.89) among current smokers. Based on pathological type, adenocarcinoma had the highest RRR (1.42; 95%CI: 0.86, 2.35), followed by squamous cancer and small cell lung cancer. Furthermore, compared with non-smoking men, current smoking men had higher risk of lung cancer than women in spite of smoking quantity, smoking duration or years since quitting.

Conclusions

These findings indicated that males had higher susceptibility for cigarette smoking-attributable lung cancer than females. It is contradicted with traditional opinion that females would be more easily suffered from cigarette smoking-attributable health problems than males. Hence, tobacco control is very crucial in both males and females.