Clinical use of microRNAs as potential non‐invasive biomarkers for detecting non‐small cell lung cancer: A meta‐analysis

Emerging studies have revealed that microRNA (miRNA) in body fluid may serve as a potential biomarker to detect non‐small cell lung cancer (NSCLC). However, the diagnostic accuracy of miRNA for NSCLC detection is still under debate because there is inconsistency in previous studies. Hence, we conducted this meta‐analysis to comprehensively evaluate the diagnostic performance of miRNA. A systematic literature search was performed to retrieve relevant articles in PubMed and other databases, and STATA 12.0 (StataCorp, College Station, TX, USA) was used to calculate the pooled parameters. A total of 28 articles involving 2121 NSCLC patients and 1582 healthy controls were included in this meta‐analysis. The overall pooled sensitivity and specificity of miRNA were 0.75 and 0.79, respectively. The pooled positive likelihood ratio was 3.6, negative likelihood ratio was 0.32 and diagnostic odds ratio was 12. The area under the curve (AUC) was 0.84. Subgroup and meta‐regression analyses established that miRNA assays were more accurate in Caucasian populations (AUC of 0.86, sensitivity of 0.79 and specificity of 0.82, respectively) than in Asian populations (AUC, sensitivity and specificity of 0.83, 0.72 and 0.80, respectively). In addition, the multiple miRNA assays (AUC of 0.89, sensitivity of 0.83 and specificity of 0.82, respectively) showed a higher accuracy than single miRNA assays (AUC, sensitivity and specificity of 0.81, 0.77 and 0.71, respectively) in NSCLC detection. Subgroup analyses based on specimen types suggested that blood‐based miRNA (AUC of 0.86, sensitivity of 0.78 and specificity of 0.80, respectively) may have a higher diagnostic accuracy as biomarkers than sputum‐based miRNA (AUC of 0.81, sensitivity of 0.69 and specificity of 0.80, respectively). In conclusion, miRNA may serve as a potential biomarker in NSCLS detection, especially the multiple miRNA from blood, with a relatively high diagnostic accuracy.     

Circulating MicroRNAs as Biomarkers in Hepatocellular Carcinoma Screening: A Validation Set From China

Hepatocellular carcinoma (HCC) is a global public health concern. Current diagnostic methods show poor performance in early-stage HCC detection. Accumulating evidences revealed the great potential of microRNAs (miRNAs) as noninvasive biomarkers in HCC detection. In this study, we examined the diagnostic performance of serum miR-10b, miR-106b, and miR-181a for HCC screening in China. Furthermore, a systematic review of previous related studies was conducted to confirm our results.One hundred eight participants including 27 HCC patients, 31 chronic liver disease (CLD) patients, and 50 healthy people were recruited in this study. Blood specimen was drawn from each participant to extract serum miRNAs. Statistical analyses were performed to assess the 3 miRNAs levels in HCC, CLD patients, and normal controls. A meta-analysis was conducted to further assess the diagnostic value of miRNAs in HCC detection based on previous studies.All these miRNAs (miR-10b, miR-181a, miR-106b) could well discriminate HCC patients from normal controls, with area under the receiver-operating characteristic curve (AUC) values of 0.85 (95% confidence interval [CI]: 0.76–0.94), 0.82 (95% CI: 0.72–0.91), and 0.89 (95% CI: 0.81–0.97), respectively. In addition, these miRNAs could distinguish HCC cases from CLD controls with a medium accuracy. However, the ability of these miRNAs in differentiating CLD patients from normal controls was not satisfactory. Panel of these miRNAs displayed a better performance compared with single miRNA assay, with AUC values of 0.94 (95% CI: 0.89–0.99) in discriminating HCC patients from normal controls and 0.91 (95% CI: 0.80–0.97) in discriminating HCC patients from CLD controls. Results of meta-analysis of previous studies combined with the current study suggested that circulating miRNAs could well differentiate HCC from normal controls, with AUC values of 0.86 (95% CI: 0.82–0.89) for single miRNA assay and 0.94 (95% CI: 0.91–0.96) for miRNA panel assay.Serum miR-10b, miR-106b, and miR-181a have great potential to serve as accurate and noninvasive biomarkers for HCC preliminary screening. Meta-analysis of previous studies combined with current study further confirmed that circulating miRNAs could play an important role in HCC detection. Further large-scale studies are needed to confirm the clinical significance of circulating miRNAs in HCC screening.     

微小核糖核酸作为急性脑梗死诊断标志物的Meta分析

目的:通过Meta分析方法,分析miRNA作为急性脑梗死诊断标志物的价值。方法:检索Medline、PubMed、Embase、Cochrane Library Database、万方数据库、中国学术期刊网全文数据库(CNKI)和维普数据库(VIP)相关文献,检索时间从建库至2018年12月。纳入的研究通过诊断准确性研究质量评价工具(QUADAS)进行质量评价,并采用Stata 14和Meta-Disc 1.4进行Meta分析,采用随机效应模型合并分析灵敏度(SEN)、特异度(SPE)、阳性似然比(PLR)、阴性似然比(NLR)和诊断比势比(DOR)。通过受试者工作特征(ROC)曲线和曲线下面积(AUC)估计整体检验效能。结果:最终共纳入19个研究,包含急性脑梗死患者1543例,对照组1037例。整体miRNA诊断急性脑梗死的SEN、SPE分别为0.82(95%CI:0.80~0.83)、0.81(95%CI:0.79~0.83),PLR为5.19(95%CI:3.61~7.47),NLR是0.24(95%CI:0.20~0.30),DOR为24.01(95%CI:14.92~38.64)。SROC曲线的AUC为0.89。结论:在诊断急性期脑梗死方面,miRNA具有较高的灵敏度,是较好的诊断标志物。     

Insights into the potential use of microRNAs as a novel class of biomarkers in esophageal cancer

MicroRNAs (abbreviated miRNAs) have been demonstrated to be involved in tumorigenesis and cancer development and proposed as promising biomarkers in cancer diagnosis. Numerous studies have observed the aberrant expression of miRNAs in esophageal cancer. However, there are some discrepant results. Thus, we conducted this meta‐analysis to identify the overall accuracy of miRNAs in the diagnosis of esophageal cancer. A comprehensive literature search was conducted in PubMed and other databases using combinations of key words. The summary receiver operator characteristic curves were plotted to assess the overall diagnostic performance of miRNAs. Chi‐squared and I² tests were used to assess the heterogeneity between studies. Additionally, we conducted subgroup and sensitivity analyses to analyze the potential sources of heterogeneity. In total, 33 studies from 12 articles were available in this meta‐analysis. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR) diagnostic odds ratio, and area under the curve were 0.80, 0.80, 4.0, 0.25, 16, and 0.87, respectively. Subgroup analyses based on the sample types (saliva‐, serum‐ and plasma‐based) showed no differences in the diagnostic accuracy of each subgroup. An independent meta‐analysis of eight articles was conducted to evaluate the diagnostic accuracy of miRNAs in patients with esophageal squamous cell carcinoma, with a pooled sensitivity of 0.77, specificity of 0.83, PLR of 4.4, NLR of 0.27, diagnostic odds ratio of 16, and area under the curve of 0.87. In conclusion, this meta‐analysis demonstrates the feasibility of using miRNAs as non‐invasive biomarkers to discriminate esophageal cancer from healthy controls. However, further high‐quality studies on more clearly defined esophageal cancer patient are needed to confirm our conclusion.     

Identification of Circulating MicroRNAs as Novel Potential Biomarkers for Gastric Cancer Detection: A Systematic Review and Meta-Analysis

Background

Recent studies show that microRNAs (miRNAs) in serum or plasma can be stably detected and used as potential biomarkers in cancer diagnosis.

Objectives

To systematically evaluate circulating miRNAs from numerous gastric cancer (GC) expression profiling studies and to determine miRNA biomarkers for GC detection.

Methods

A systematic review and meta-analysis of published studies comparing the circulating miRNA expressions between GC patients and healthy controls were carried out. An miRNA ranking system that considered the number of comparisons in agreement, total number of samples, and average fold change was used. Then the receiver-operating characteristic curve (ROC) results of the top miRNAs were combined to further evaluate their diagnostic value by using Meta-disc 1.4.

Results

A total of 35 miRNAs were reported in the 22 included studies, with 7 miRNAs reported in at least 2 studies. MiR-21 is the most consistently reported miRNA with upregulation. In further analysis, the sensitivity, specificity, and area under the curve of summary ROC for miR-21 in GC diagnosis are 0.78 (95 % CI 0.71–0.85), 0.89 (95 % CI 0.82–0.94), and 0.91, respectively.

Conclusion

Circulating miR-21 can serve as a potential biomarker for detection of GC.     

Diagnostic accuracy of miRNAs as potential biomarkers for systemic lupus erythematosus: a meta-analysis

To systematically evaluate the diagnostic accuracy of miRNAs as potential biomarkers for systemic lupus erythematosus (SLE). Studies were searched in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) disc database, and languages were limited in English and Chinese. QUADAS-2 tool was applied to assess the quality of eligible studies. Random-effect model was applied to calculate pooled effects of miRNAs on diagnosing SLE. Subgroup analysis was used to explore the sources of heterogeneity. All data were calculated and analyzed by Meta-Disc 1.4 and RevMan 5.3 software. Six eligible studies were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of miRNAs were 0.75(95% CI 0.71–0.79), 0.72(95% CI 0.66–0.78), and 8.79(95% CI 4.91–15.73), respectively. The pooled positive likelihood ratio was 2.71(95% CI 2.20–3.33) and negative likelihood ratio was 0.34(95% CI 0.24–0.48). The area under the curve was 0.787. The subgroup analysis showed that the number of healthy controls might be the sources of heterogeneity. MiRNAs in blood have moderate accuracy and influence on diagnosing SLE, and the exact diagnostic value should be confirmed by further studies.     

Circulating microRNAs for the diagnosis of hepatocellular carcinoma

AimThere are no existing biomarkers that demonstrate very reliable performance in the diagnosis of hepatocellular carcinoma (HCC), especially in the early stage. Studies have shown that numerous aberrantly expressed circulating microRNAs (miRNAs) can be used as a diagnostic tool for HCC; however, these studies have produced inconsistent results.MethodsWe performed a meta-analysis to summarize the diagnostic accuracy of circulating miRNAs, alpha-fetoprotein (AFP), and AFP combined with miRNAs in differentiating HCC patients from non-HCC controls, healthy controls and chronic liver disease controls. We also evaluated the diagnostic accuracy of circulating miRNAs for early-stage HCC. Furthermore, we systematically reviewed the diagnostic effectiveness of single miRNAs and individual miRNA panels.ResultsCirculating miRNAs showed good diagnostic performance. Compared with single miRNAs, the diagnostic accuracy of miRNA panels was clearly better. The combination of AFP and miRNAs improved the diagnostic accuracy compared with the use of miRNAs or AFP alone. For early-stage HCC patients, circulating miRNAs exhibited relatively satisfactory diagnostic accuracy.ConclusionsCirculating miRNAs can be used as an early diagnostic marker of HCC. The combination of miRNAs and AFP has great potential as a novel strategy for the diagnosis of HCC.     

SDC2基因甲基化对结直肠癌诊断价值的Meta分析

目的 通过Meta分析方法评价多配体蛋白聚糖2(Syndecan-2,SDC2)基因甲基化作为生物标志物诊断结直肠癌(colorectal cancer,CRC)的价值.方法 计算机检索PubMed、Cochrane Library、Embase、Web of Science、CBM、万方、知网、维普数据库,查找建库至...     

超声内镜引导下细针穿刺活检对胰腺实性占位定性诊断价值的Meta分析

目的:系统评价超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺实性占位定性诊断中的价值.方法:计算机检索MEDLINE、Cochrane Library、中国生物医学文献数据库、万方数据库、中国学术期刊全文等数据库,检索时间均为建库至2011-10.全面查找有关EUS-FNA诊断胰腺实性占位的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据QUADAS质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC).结果:共检索出相关文献280篇,按照文献纳入标准,最终纳入18篇文献(均为英文文献).EUS-FNA对胰腺实性占位定性诊断价值分别为:汇总敏感度为0.90[95%CI(0.89-0.92)],汇总特异度为0.95[95%CI(0.93-0.97)],汇总阳性似然比为13.56[95%CI(8.31-22.15)],汇总阴性似然比为0.12[95%CI(0.10-0.15)],汇总诊断优势比为143.62[95%CI(93.98-219.46)],SROC曲线下面积AUC为0.9711,Q*=0.9215.另外,本研究还对有无病理医生在场指导进行了亚组分析,发现有病理医生在场的AUC为0.9757,Q*=0.9295.且汇总诊断优势比173.37[95%CI(98.09-306.44)],明显较无病理医生在场的113.64[95%CI(60.22-214.46)]高.结论:经SROC曲线证实,EUS-FNA活检在胰腺实性占位定性诊断中具有较高的灵敏度和特异度,尤其是有病理医生在场指导的情况下,可作为临床上胰腺实性占位定性诊断的重要检查手段.     

Clinical Diagnostic Implications of Body Fluid MiRNA in Oral Squamous Cell Carcinoma: A Meta-Analysis

Oral cancer, predominantly oral squamous cell carcinoma (OSCC), is one of the most leading causes of cancers worldwide. Due to a low 5-year survival rate, highly effective methods for the early detection of OSCC are totally needed. MicroRNAs (miRNAs), as promising biomarkers, can bring insights into tumorigenesis of oral cancers. However, studies on the accuracy of miRNAs detection in OSCC have inconsistent conclusions, leading us to conduct this meta-analysis. The aim of this study was to systematically review the articles investigating the diagnostic value of miRNAs in OSCC.The PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), Web of Science were searched (updated to June 11th, 2015) to identify all articles evaluating the diagnostic yield of miRNAs for OSCC. The pooled sensitivity, specificity, and other diagnostic parameters were used to assess the performance of miRNAs assays on OSCC detection. Statistical analysis was conducted by employing the R software.The present meta-analysis comprised 23 studies from 10 articles, including 598 OSCC patients and 320 healthy individuals, available for analysis. The summary receiver operator characteristic (SROC) curve was plotted. Meanwhile, the pooled diagnostic parameters and the area under curve (AUC) were calculated based on all included studies. The pooled diagnostic parameters calculated from all 23 studies were as follows: pooled sensitivity of 0.759 (95% CI: 0.701–0.809), pooled specificity of 0.773 (95% CI: 0.713–0.823) and AUC of 0.832, which indicates a relatively high diagnostic accuracy of miRNAs in differentiating OSCC patients from healthy controls. Meanwhile, In addition, subgroup analyses were conducted to access the heterogeneity between studies, which is based on specimen (serum/plasma/blood/saliva/ tissue) and ethnicity (Asian/Caucasian).In summary, our meta-analysis suggests that miRNAs might be used in noninvasive screening tests for OSCC, which needs further large-scale studies to be validated.     

Body mass index and risk of pneumonia: a systematic review and meta‐analysis

The aims of our meta‐analysis were to examine the pattern and gender's influence on body mass index (BMI) – pneumonia relationship. Published studies were searched from PubMed, Web of Science, Cochrane Library databases using keywords of pneumonia, BMI and epidemiologic studies. Random‐effects analysis was applied to estimate pooled effect sizes from individual studies. The Cochrane Q‐test and index of heterogeneity (I²) were used to evaluate heterogeneity, and Egger's test was used to evaluate publication bias. Random‐effects meta‐regression was applied to examine the pattern and gender's influence on BMI–pneumonia relationship. A total of 1,531 studies were initially identified, and 25 studies finally were included. The pooled relative risk (RR) and meta‐regression model revealed a J‐shaped relationship between BMI and risk of community‐acquired pneumonia (underweight, RR 1.8, 95% confidence interval [CI], 1.4–2.2, P < 0.01; overweight, 0.89, 95%CI, 0.8–1.03, P, 0.1; obesity, 1.03, 95% CI, 0.8–1.3, p. 8) and U‐shaped relationship between BMI and risk of influenza‐related pneumonia (underweight, RR 1.9, 95% CI, 1.2–3, P < 0.01; overweight, 0.89, 95% CI, 0.79–0.99, P, 0.03; obesity, 1.3, 95% CI, 1.05–1.63, p. 2; morbidity obesity, 4.6, 95% CI, 2.2–9.8, P < 0.01); whereas, no difference in risk of nosocomial pneumonia was found across the BMI groups. Gender difference did not make significant contribution in modifying BMI–pneumonia risk relationship.     

Diagnostic accuracy of dual‐source computed tomography angiography for the detection of coronary in‐stent restenosis: A systematic review and meta‐analysis

We sought to perform a meta‐analysis to comprehensively evaluate the diagnostic accuracy of dual‐source computed tomography angiography (DSCTA) in detecting coronary in‐stent restenosis (CISR) when compared to invasive coronary angiography. The stent‐based research studies in which DSCTA was used as diagnostic tool for CISR, as recent as of October 2017, from several reputed scientific libraries (PubMed, Embase, Scopus, The Cochrane Library, and Web of Science) were evaluated. Study inclusion, data extraction, and risk bias assessment were conducted by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under summary receiver operator characteristics (SROC) curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were also carried out. A total of 13 studies with a total of 894 patients and 1384 assessable stents were included. The pooled results of DSCTA diagnosing CISR were as follows: SEN 0.92 (95% confidence interval [CI] 0.87–0.96), SPE 0.91 (95% CI 0.87–0.94), PLR 9.83 (95% CI 6.93–13.94), NLR 0.09 (95% CI 0.05–0.15), DOR 114.73 (95% CI 64.12–205.28), and AUC 0.97 (95% CI 0.95–0.98), respectively. The subgroup analysis result suggested that DSTCA performed significantly better in CISR detection when the stent diameter was ≥3 mm compared with the stent diameter <3 mm: (0.98 [0.97–0.99] vs 0.82 [0.79–0.86]) with P < .05. This study revealed that DSCTA has excellent diagnostic performance for detecting CISR and may serve as an alternative for further patient evaluation with CISR, especially for stent diameter ≥3 mm.     

A Comprehensive Meta-Analysis of MicroRNAs for Predicting Colorectal Cancer

Colorectal cancer (CRC) has been defined as a common malignancy due to its prevailing incidence in both males and females. Recently, the intrinsic value of microRNAs (miRNAs) with respect to early cancer diagnosis has been contentious as the diagnostic accuracy of miRNAs significantly varied across different studies. As a result of this, this pioneer meta-analysis was proposed to address this issue.Qualified studies were obtained through electronic systematical searching in Medline, Embase, and PubMed. On the basis of the random-effects model, we calculated the pooled sensitivity (SEN), specificity (SPE), and area under the receiver operating characteristics curve (AUC) to assess the diagnostic accuracy of miRNAs. Subgroup analysis and meta-regression were implemented to determine how different confounding factors affect the overall diagnostic accuracy which were considered important sources of heterogeneity. All the statistical analyses were conducted with R 3.2.1 software.We incorporated 103 studies from 36 articles with a total of 3124 CRC patients and 2579 healthy individuals. MiRNAs have a good performance with the following pooled estimates: SEN = 0.769 (95% CI = 0.733–0.802), SPE = 0.806 (95% CI = 0.781–0.829), AUC = 0.857, and partial AUC = 0.773. As suggested by subgroup analyses and meta-regression, multiple miRNAs appeared to be more favorable than single miRNA (AUC: 0.918 > 0.813, partial AUC: 0.848 > 0.701, sensitivity = 0.853 > 0.718, specificity = 0.860 > 0.772). Compared with samples of plasma, blood, tissue, and feces, miRNA obtained from serum samples were more powerful for detecting CRC particularly in Asian.Our study provided exclusive evidence that multiple miRNAs extracted from serum samples had superior diagnostic performance over single miRNA for screening CRC. Therefore, this approach that is characterized by high specificity and noninvasive nature may assist in early diagnosis of CRC particularly in Asian.     

Gut microbiota‐derived metabolite trimethylamine N‐oxide (TMAO) potentially increases the risk of obesity in adults: An exploratory systematic review and dose‐response meta‐ analysis

It has been suggested that trimethylamine N‐oxide (TMAO) is associated with increased risk of diabetes and cardiovascular disease (CVD) morbidity and mortality. However, it is not known whether increased TMAO concentrations is associated with obesity. In the current study, we summarized the evidence related to the association of circulating TMAO with the risk of obesity measurements, including body mass index (BMI), waist circumference (WC), and waist‐to‐hip ratio (WHR) in a two‐class and dose‐response meta‐analysis of observational studies. A systematic search carried out in PubMed, SCOPUS, Cochrane, and ProQuest through September 30, 2019 resulted in 12 eligible studies which were included in the current meta‐synthesis. In these studies, BMI was reported but there were no reports of WC or WHR. Meta‐analysis of two‐class variables and dose‐response meta‐analysis of continuous variables were performed. Subgroup analysis and meta‐regression were also performed to identify the source of heterogeneity. There was a dose‐response association between circulating TMAO concentration and increased BMI in studies involving healthy individuals (P nonlinearity = .007), while no evidence of departure from linearity was observed according to study design or among patients with CVD. Results showed the highest category of TMAO was associated with 0.56 kg/m² increase in BMI (weighted mean difference [WMD], 0.563; CI, 0.026‐1.100; P = .04). The results of the current meta‐analysis revealed a positive association between circulating TMAO and obesity as presented by increased BMI. Moreover, a dose‐dependent association between circulating TMAO and obesity was also identified in apparently healthy individuals. This is the first meta‐analysis to reveal positive dose‐dependent associations between circulating TMAO concentration and obesity.     

Hyperuricemia and the Prognosis of Hypertensive Patients: A Systematic Review and Meta‐Analysis

The aim of this study was to assess the prognostic value of hyperuricemia in patients with established hypertension by systematic review and meta‐analysis of cohort studies. MEDLINE, Embase, and the Chinese Biomedical Literature Database were searched through January 2015. Seventeen cohort studies were included and their methodological quality was moderate to high, with Newcastle‐Ottawa Scale scores ranging from 6 to 9. Random‐effects model meta‐analyses showed that in terms of adjusted categorical data, hyperuricemia significantly correlated with cardiovascular diseases in hypertensive patients (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.13–2.03), all‐cause mortality (HR, 1.12; 95%CI, 1.02–1.23), and diabetes (HR, 1.84; 95% CI, 1.02–3.30) but not with stroke (HR, 0.85; 95%CI, 0.57–1.27); while, in terms of adjusted continuous data, the corresponding pooled HRs were 1.17 (95% CI, 1.07–1.27), 1.05 (95% CI, 0.98–1.13), 1.28 (95% CI, 1.18–1.38), and 1.06 (95% CI, 0.98–1.16), respectively. The findings of our meta‐analysis suggest that hyperuricemia could slightly increase the risk of cardiovascular diseases and diabetes in patients with hypertension.     

Meta-analysis: circulating adiponectin levels and risk of colorectal cancer and adenoma

OBJECTIVE: To provide a systematic review with a meta‐analysis for addressing the association between circulating adiponectin levels and the risk of colorectal cancer and adenoma. METHODS: Multiple electronic sources including MEDLINE, EMBASE and the Science Citation Index Expanded databases were searched to identify relevant studies for this systematic review. All existing observational studies that examined the relationship between circulating adiponectin and colorectal cancer or adenoma were included. Weighted mean difference and 95% confidence intervals (CI) were estimated and pooled using meta‐analysis methods. RESULTS: Overall 13 case control or nested case control studies met the inclusion criteria. A total of 6175 participants and 3015 cases of colorectal cancer and adenoma were included in this meta‐analysis. The weighted mean difference (95% CI) were ?1.084 µg/mL (?1.836, ?0.331), P = 0.005 in colorectal cancer and ?1.43 µg/mL (?2.231, ?0.628), P = 0.000 in adenoma. In men, a 2% decreased risk of colorectal neoplasm for a 1 µg/mL increment in adiponectin levels was observed (OR = 0.98, 95% CI 0.96–0.99) whereas among women there is no evidence of such a trend (OR = 0.99, 95% CI 0.97–1.01). CONCLUSIONS: Patients with colorectal cancer and adenoma demonstrated markedly lower adiponectin values than controls, yet there was significant heterogeneity among studies. A negative dose response relationship between levels of adiponectin and the risk of colorectal neoplasm was observed in men.     

Immune response to hepatitis B vaccine in patients with chronic hepatitis C infection: A systematic review and meta‐analysis

Hepatitis B virus and hepatitis C virus (HCV) co‐infection can add to the severity of hepatitis and the risks of liver cirrhosis and hepatocellular carcinoma. Whether chronic HCV infection decreases antibody response to hepatitis B vaccination is still controversial. We evaluate the influence of HCV infection on antibody response to hepatitis B vaccination by a systematic review of published works with a meta‐analysis of clinical trials. The random‐effects model of DerSimonian and Laird with heterogeneity and sensitivity analyses were used in this study. The end‐point of interest was the rate of patients showing seroconversion of antibody responses at completion of hepatitis B vaccination schedule among patients with chronic HCV infection versus healthy controls. We identified 11 studies involving 704 patients with HCV and 812 controls. Our results show a significant decrease in antibody seroconversion rates among patients with HCV versus healthy controls (pooled odds ratio = 0.17 [95% confidence interval, 0.11–0.28]). The P‐value was 0.21 for our test of study heterogeneity. Stratified analysis in subgroups of interest and sensitivity analysis did not meaningfully change our results. Our meta‐analysis showed patients with hepatitis C infection have a statistically significant lower rate of seroconversion in comparison to healthy controls, both in cirrhotic and non‐cirrhotic patients. Chronic HCV infection can decrease the immune response to a standard schedule of hepatitis B vaccination. Further studies are needed to investigate the optimum vaccination schedule for patients with chronic HCV infection.