Prognostic and clinicopathological significance of survivin expression in bladder cancer patients: a meta-analysis

Survivin has been widely reported to play a role in diagnosis and prognosis of bladder cancer patients. However, published data on this subject are heterogeneous. Here, we conducted a meta-analysis to obtain a complete evaluation of the association between survivin and recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), and odds ratio (OR) in bladder cancer patients. Published studies on this subject were selected for further assessment by online articles in PubMed, MEDLINE, EMBASE, and OVID databases. Pooled hazard ratios (HR) with 95 % confidence interval (95 % CI) were estimated. Funnel plots were used to evaluate the publication bias. As well, heterogeneity and sensitivity were analyzed. In this meta-analysis, we included 13 studies with the total number of 1,963 patients. Positive survivin expression in bladder cancer was associated with a poor RFS (HR, 1.831; 95 % CI, 1.344–2.49), DSS (HR, 1.721; 95 % CI, 1.477–2.004), or OS (HR, 1.753; 95 % CI, 1.092–2.816) in patients. In addition, a significant association between expression of survivin and age (OR, 0.641; 95 % CI, 0.416–0.987) as well as stage (OR, 0.37; 95 % CI, 0.190–0.750) was revealed. Heterogeneity was observed among the included studies with RFS (x ²?=?29.58, p?=?0.009, I ²?=?52.7 %), OS (x ²?=?15.67, p?=?0.008, I ²?=?68.1 %), and stage (x ²?=?11.97, p?=?0.035, I ²?=?58.2 %). There was no publication bias according to Begg’s and Egger’s tests except for studies with gender. Furthermore, sensitivity analysis obtained the source of heterogeneity and confirmed opposite results of some studies. This study suggests that expression of survivin indicates poor prognosis in older patients and muscle invasive or advanced stage in bladder cancer. Survivin expression could be used in identifying a subgroup of patients with potential to benefit from a targeted therapy against survivin.     

弥漫大B细胞淋巴瘤患者体质量指数对预后影响的Meta分析

目的:系统评价体质量指数（BMI）对弥漫大B细胞淋巴瘤（DLBCL）患者预后的影响。方法:计算机检索PubMed、Medline、Web of Science等数据库,按照纳入及排除标准筛选关于BMI与DLBCL患者预后关系的临床研究文献,采用RevMan 5.3软件对各研究的总生存（OS）、无进展生存（PFS）的风险比（ HR）及95%置信区间（95% CI）等数据进行分析,同时评估纳入文献质量、偏倚风险及异质性。 结果:共12篇文献纳入研究。Meta分析结果显示,与正常体质量（BMI 18.5~24.9 kg/m 2）患者相比,超重（BMI 25.0~29.9 kg/m 2）患者OS和PFS时间更长,但差异均无统计学意义（OS： HR=0.93,95% CI 0.78~1.11, P=0.42;PFS： HR=0.89,95% CI 0.67~1.20, P=0.45）;低体质量（BMI<18.5 kg/m 2）患者（OS： HR=1.97,95% CI 1.41~2.74, P<0.01;PFS： HR=1.89,95% CI 1.19~3.03, P<0.01）和肥胖（BMI≥30.0 kg/m 2）患者OS和PFS时间更短,但后者差异无统计学意义（OS： HR=1.15,95% CI 0.88~1.51, P=0.31;PFS： HR=1.32,95% CI 0.90~1.94, P=0.15）。漏斗图对称,纳入文献无发表偏倚。 结论:一定范围内BMI升高是DLBCL患者预后的保护性因素。     

Survival benefit of hepatic resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Background

No consensus treatment has been reached for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Hepatic resection (HR) and transarterial chemoembolization (TACE) have been recommended as effective options, but which is better remains unclear. This meta-analysis is to compare the effectiveness of HR and TACE for HCC with PVTT patients.

Methods

The PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched for comparing HR and TACE treating PVTT.

Results

Twelve retrospective studies with 3129 patients were included. A meta-analysis of 11 studies suggested that the 1-, 2-, 3-, and 5-year overall survival (OS) rates (OR?=?0.48, 95% CI?=?0.41–0.57, I² =?37%, P?<?0.00001; OR?=?0.21, 95% CI?=?0.12–0.38, I² =?43%, P?<?0.00001; OR?=?0.35, 95% CI?=?0.28–0.44, I² =?53%, P?<?0.00001; OR?=?0.28, 95% CI?=?0.14–0.54, I² =?72%, P?=?0.0001, respectively) favored HR over TACE. In a subgroup analysis, HR had better 1-, 2-,3, 5-year OS for type I PVTT (OR?=?0.33, 95% CI?=?0.17–0.64, I² =?20%, P?=?0.001; OR?=?0.32, 95% CI?=?0.16–0.63, I2?=?0%, P?=?0.001; OR?=?0.18, 95% CI?=?0.09–0.36, I2?=?0%, P?<?0.00001; OR?=?0.07, 95% CI?=?0.01–0.32, I2?=?0%, P?=?0.0006, respectively) and better 1-, 3-, and 5-year OS for type II PVTT (OR?=?0.37, 95% CI?=?0.20–0.70, I² =?59%, P?=?0.002; OR?=?0.22, 95% CI?=?0.13–0.39, I² =?0%, P?<?0.00001; OR?=?0.16; 95% CI?=?0.03–0.91; I² =?51%, P?=?0.04, respectively). There was no difference in 1-, 3-, or 5-year OS between HR and TACE for type III PVTT (OR?=?0.86, 95% CI?=?0.61–1.21, I² =?0%, P?=?0.39; OR?=?0.83, 95% CI?=?0.42–1.64, I² =?0%, P?=?0.59; OR?=?0.59, 95% CI?=?0.06–-6.04, I² =?65%, P?=?0.66, respectively).

Conclusions

HR may lead to longer OS for some selected HCC patients with PVTT than TACE, especially for type I or II PVTT, with less difference being observed for type III or IV PVTT.

     

Chemoradiotherapy alone vs. chemoradiotherapy and hysterectomy for locally advanced cervical cancer: A systematic review and updated meta-analysis

The benefit of adjuvant hysterectomy after definitive concurrent chemoradiotherapy (CCRT) for locally-advanced cervical cancer (LACC) is controversial. The purpose of the present study was to systematically search the literature and perform a meta-analysis to compare overall survival (OS) and disease-free survival (DFS) between patients subjected to CCRT with hysterectomy and those who underwent CCRT alone. The PubMed, Scopus, Embase and Google scholar databases were searched. A meta-analysis to determine hazard ratios (HRs) and odds ratios (ORs) with meta-regression was performed for the following moderators: Disease stage, histology and proportion of radical hysterectomy. Data from 14 studies were included. The results indicated that patients who received CCRT with hysterectomy had significantly better OS (HR, 0.72; 95% CI, 0.56 to 0.91; I²=19%; P=0.007) and DFS (HR, 0.72; 95% CI, 0.56 to 0.93; I²=27%; P=0.01) than those treated with CCRT alone. However, in a subgroup analysis by study type, the results were significant only for retrospective studies but not for randomized controlled trials (RCTs). However, only 2 RCTs were included with small sample size, heterogeneity and low overall quality. Subgroup analyses based on the use of brachytherapy in the CCRT with hysterectomy group demonstrated no difference in OS and DFS between the two groups. Regarding the absolute numbers of death and recurrence events, no significant difference in mortality (OR, 0.91; 95% CI, 0.62 to 1.33; I²=0%; P=0.64) was determined between the two groups, but a significantly reduced incidence of recurrence was observed in the CCRT with hysterectomy group (OR, 0.61; 95% CI, 0.47-0.79; I²=29%; P=0.0002). The meta-regression results point to a significant influence of the proportion of stage II patients on OS. Despite the overall analysis indicating improved OS and DFS with the use of adjuvant hysterectomy after CCRT, subgroup analysis based on similar treatment protocols failed to demonstrate any significant benefit of hysterectomy in LACC. However, the results indicated that the recurrence rate may be higher in patients undergoing CCRT without hysterectomy. The limited quality of the studies included and selection bias from retrospective studies restrict the possibility to draw strong conclusions.     

The prognosis and clinicopathology of CXCR4 in gastric cancer patients: a meta-analysis

The chemokine receptor 4 (CXCR4) has been widely investigated in diagnosis and prognosis of gastric cancer (GC). However, the impact of CXCR4 on GC patients remains controversial; Here, we conducted a meta-analysis to obtain the precise role of CXCR4 in GC prognosis and clinicopathology. Thirteen published studies with a total of 1,936 patients were included. Original data included the hazard ratio (HR) of overall survival (OS) and odds ratio (OR) in GC patients. We combined HR/OR with 95 % confidence interval (CI) to estimate the hazard. In this study, OS was significantly related to CXCR4 expression, with the HR 2.63 (95 % CI 1.69–4.09; p?<?0.0001), and a significant correlation was also revealed between CXCR4 expression and stage (I?+?II, +) (OR 0.52, 95 % CI 0.32–0.83; p?=?0.007), depth of invasion (T1/T2, +) (OR 0.44, 95 % CI 0.27–0.73; p?=?0.001), lymph node metastasis (LN, +) (OR 2.30, 95 % CI 1.57–3.36; p?<?0.0001), as well as vascular invasion (vas.inv, +) (OR 0.72, 95 % CI 0.53–0.98; p?=?0.04). Heterogeneity was observed among the included studies with OS (I ²?=?51 %), stage (I ²?=?78 %), depth of invasion (I ²?=?74 %), lymph node metastasis (I ²?=?64 %), and histology differentiation (I ²?=?79 %). No publication bias was observed. In conclusion, this meta-analysis showed CXCR4 expression indicates poor prognosis in GC patients with advanced stage or deep invasion in GC tissues, which also implied lymph node metastasis and vascular invasion. Thus, CXCR4 could help predict patient prognosis and guide clinical diagnosis and treatment.     

Postoperative adjuvant transarterial chemoembolization for intrahepatic cholangiocarcinoma patients with microvascular invasion: a propensity score analysis

BackgroundMicrovascular invasion (MVI) is an independent risk factor associated with tumor recurrence and poor survival in patients with intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy (PH). The potential impact of adjuvant TACE on the prognosis of patients with ICC involving MVI (ICC-MVI) remains uncertain. Our aim was to investigate the effectiveness of postoperative adjuvant transarterial chemoembolization (TACE) on ICC involving MVI.MethodsMulticentric data consisted of 223 patients who underwent curative-intent PH for ICC-MVI from 2002–2015 were retrospectively analyzed. The impact of adjuvant TACE was evaluated using inverse probability of treatment weighting (IPTW) and propensity-score matched (PSM) analyses.ResultsNo association between the TACE and the overall survival (OS) and recurrence rates was observed among the overall ICC-MVI patients. However, subgroup analyses revealed that adjuvant TACE favored OS (HR, 0.62; 95% CI, 0.39–0.99; P=0.047) and time to recurrence (TTR) (HR, 0.59; 95% CI, 0.36–0.97; P=0.037) among patients with elevated CA19-9 and those without lymphadenectomy (HR, 0.53; 95% CI, 0.30–0.93; P=0.027 for OS, and HR, 0.49; 95% CI, 0.28–0.87; P=0.015 for TTR, respectively). In the CA19-9 ≥39 U/L subgroup and Nx subgroup, adjuvant TACE was associated with higher 1-, 3-, and 5-year OS rates (P=0.033 and P=0.034, respectively) and lower corresponding recurrence rates (P=0.024 and P=0.023, respectively).ConclusionsAmong the ICC-MVI patients undergoing curative-intent PH, only those have elevated CA19-9 or who did not undergo lymphadenectomy might be suitable for adjuvant TACE.     

The prognostic role of neutrophil-to-lymphocyte ratio and C-reactive protein in metastatic colorectal cancer using regorafenib: a systematic review and meta-analysis

BackgroundThe application of regorafenib has changed the landscape of subsequent-line treatment in metastatic colorectal cancer (mCRC). Baseline neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP), as two of the most common inflammatory factors, are suggested to be potential prognostic factors for mCRC patients treated with regorafenib, but the results are conflicting. In this study, we conducted a meta-analysis to evaluate the prognostic role of NLR and CRP in mCRC patients treated with regorafenib.MethodsWe searched online databases such as Embase, PubMed, and the Cochrane library up to April 2022, without language limitation, to identify clinical studies evaluating the prognostic role of NLR or CRP in regorafenib treated mCRC patients. The main endpoints were hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS). The associations between NLR, CRP, and the above endpoints were extracted. Review Manager 5.4 was used to conduct the combined analysis. The Newcastle-Ottawa Scale (NOS) was applied for assessing the quality of included studies. Heterogeneity was detected by chi-square-based Q test and I² statistic, and publication bias was evaluated by funnel plot asymmetry and Egger’s test.ResultsEight studies involving 1,287 cases were included, with 5 reporting survival outcomes based on NLR level and 4 reporting survival according to CRP level. The results of meta-analysis showed that the calculated HR of OS for subsequent-line regorafenib in mCRC patients with high versus low NLR was 2.52 [I²=52%, 95% confidence interval (CI): 1.75–3.64; P<0.00001]. The combined HR of PFS with high versus low baseline NLR was 2.11 (I²=12%, 95% CI: 1.80–2.48; P<0.00001). For patients with a high level of CRP, the OS was significantly shorter when compared with patients with a low level of CRP (I²=0%, HR =1.88; 95% CI: 1.55–2.29; P<0.00001).ConclusionsHigh level of NLR could be associated with OS in mCRC patients treated with regorafenib. It is suggested that the impact of regorafenib on OS may vary according to the baseline NLR.     

Prognostic significance of p53 expression in malignant bone tumors: a meta-analysis

Osteosarcoma and Ewing’s sarcoma are the two most common primary malignant bone tumors, and findings of prognostic factors are important for clinicians to decide treatment options. High p53 expression has been implicated in tumor development and progression, but studies investigating the prognostic role of p53 overexpression in malignant bone tumors report conflicting findings. We performed a meta-analysis to assess the relationship between p53 overexpression and the survival of malignant bone tumors. A meta-analysis of 13 studies with a total of 703 patients was carried out to evaluate the association between p53 overexpression and overall survival (OS) and disease-free survival (DFS) in patients with malignant bone tumors. The pooled hazard ratio (HR) with its 95 % confidence interval (CI) was used as the effect size estimate. There was no between-study heterogeneity in both OS studies (I ²?=?0.0 %) and DFS studies (I ²?=?0.0 %). Overall, high p53 expression predicted both poor OS (HR 2.13, 95 % CI 1.81–2.52, P?<?0.001) and poor DFS (HR 2.06, 95 % CI 1.58–2.69, P?<?0.001) in patients with malignant bone tumors. Subgroup analyses by tumor types suggested that p53 expression predicted poor OS in both osteosarcoma patients (HR 2.15, 95 % CI 1.78–2.60, I ²?=?15.2 %, P?<?0.001) and Ewing’s sarcoma patients (HR 2.09, 95 % CI 1.47–2.97, I ²?=?0.0 %, P?<?0.001). Besides, p53 expression also predicted poor DFS in both osteosarcoma patients (HR 2.38, 95 % CI 1.60–3.52, I ²?=?0.0 %, P?<?0.001) and Ewing’s sarcoma patients (HR 1.83, 95 % CI 1.28–2.63, I ²?=?0.0 %, P?=?0.001). Egger’s test also did not suggest evidence for publication bias in both OS studies (P?=?0.615) and DFS studies (P?=?0.258). High p53 expression indicates a poorer prognosis for patients with osteosarcoma and Ewing’s sarcoma.     

Prognostic value of survivin expression in breast cancer patients: a meta-analysis

The prognostic role of survivin expression in breast cancer patients has been widely reported. However, controversy still remains. Thus, a meta-analysis was conducted to obtain a more precise estimation of the relationship between survivin expression and overall survival (OS) in breast cancer patients. Relevant articles were selected for further assessment by online search in PubMed, EMBASE, and China National Knowledge Infrastructure. Pooled hazard ratios (HR) with 95 % confidence interval (95 % CI) were used to estimate the strength of the association between survivin expression and OS in breast cancer patients. Funnel plots of Begger’s and Egger’s linear regression test were used to evaluate the publication bias. Heterogeneity and sensitivity analysis were also assessed. Fifteen studies were included in the final analysis with the total number of 2,202 patients. There was a significant association between positive survivin expression and a poor OS consequence in patients with breast cancer (pooled HR 1.80, 95 % CI 1.55–2.09). No significant heterogeneity was observed among all the eligible studies (x ²?=?21.87, p?=?0.081, I ²?=?36.0 %). Publication bias was absent. Sensitivity analysis revealed that the results of this meta-analysis were robust. Our results suggested that high survivin expression had an unfavorable prognostic role for patients with breast cancer.     

A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours

IntroductionThere is increasing evidence to suggest that cancer-associated inflammation is associated with poorer long-term outcomes. Various markers have been studied over the past decade in an attempt to improve selection of patients for surgery. This meta-analysis explored the association between the neutrophil-lymphocyte ratio and prognosis following curative-intent surgery for solid tumours.MethodsStudies were identified from US National Library of Medicine (Medline) and the Exerpta Medica database (EBASE) performed in March 2013. A systematic review and meta-analysis were performed to generate combined hazard ratios for overall survival (OS) and disease-free survival (DFS).ResultsForty-nine studies containing 14282 patients were included. Elevated NLR was associated with poorer overall survival [HR: 1.92, 95% CI (1.64–2.24)] (p < 0.001) and disease-free survival [HR: 1.99, 95% CI (1.80–2.20)] (p < 0.001). Significant heterogeneity was found with an I² of 77% and 97% for OS and DFS respectively. Subgroup analyses demonstrated that gastro-intestinal malignancies; mainly gastric [HR: 1.97, 95% CI (1.41–2.76)], colorectal [HR: 1.65, 95% CI (1.21–2.26)] and oesophageal [HR: 1.48, 95% CI (0.91–2.42)] cancers were predictive of OS (I² = 54.3%). A separate analysis for studies using an NLR cutoff of 5 demonstrated significantly poorer outcomes [HR: 2.18, 95% CI (1.74–2.73)] (p = 0.002) with less heterogeneity (I² = 58%).ConclusionElevated NLR correlates with poorer prognosis. It potentially represents a simple, robust and reliable measure that may be useful in identifying high-risk groups who could benefit from adjuvant therapy.     

Role of EGFR as a prognostic factor for survival in head and neck cancer: a meta-analysis

The prognostic role of epidermal growth factor receptor (EGFR) in head and neck squamous cell carcinoma (HNSCC) remains controversial. The goal of this study was to summarize existing evidence regarding whether EGFR overexpression is a prognostic factor in HNSCC. Relevant studies were identified using Pubmed, Ovid, and Web of Science databases. A meta-analysis was conducted on the prognostic value of EGFR expression for overall survival (OS) and disease-free survival (DFS). Thirty-seven studies were included. Primary analysis indicated that EGFR overexpression was associated with reduced OS (hazard ratio [HR]: 1.694, 95 % confidence interval [CI]: 1.432–2.004). DFS, on the other hand, was not associated with EGFR expression after adjusting for publication bias (HR: 1.084, 95 % CI: 0.910–1.290). Subgroup analysis gave a statistically significant pooled HR for OS in laryngeal carcinoma (HR: 2.519, 95 % CI: 1.615–3.928) and in oropharyngeal carcinoma (HR: 2.078, 95 % CI: 1.605–2.690). The pooled HR was statistically significant for DFS with respect to oropharyngeal carcinoma (HR: 1.055, 95 % CI: 1.020–1.092), but not laryngeal carcinoma (HR: 1.750, 95 % CI: 0.911–3.360). When dividing studies based on the immunohistochemistry (IHC) scoring system, only the group that evaluated EGFR expression according to the intensity and extent of staining showed no between-study heterogeneity for both OS and DFS. Overall, EGFR overexpression was associated with shortened OS, but not DFS. Future studies are needed that stratify patients by specific tumor sites. Furthermore, when estimating protein level by the IHC method, it is advisable to consider both intensity and extent of staining.     

Ki-67 as a Prognostic Marker in Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Background

We systematically evaluated the prognostic significance of Ki-67 on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

The Effect of LINC01296 Expression in Patients with Cancer: A Systematic Review and Meta-Analysis

Background: Recently has been suggested that LINC01296 has an important role in tumor-promoting in different malignancies. We performed first meta-analysis to assess the association between the LINC01296 expression and clinicopathological criteria and the survival of patients with cancers. Methods: Relevant articles Identified by PubMed, EMBASE, Web of Science, and Scopus searching between December 2000 and 28 December 2018. Binomial data were evaluated by the odds ratio (OR) as the rapid statistic. The association between overall survival (OS) and the LINC01296 expression was evaluated using pooling the hazard ratio (HR) with its corresponding 95% confidence interval (CI). Results: Finally, 9 studies with 720 patients with cancer were included. The expression of LINC01296 showed a significant positive association with TNM stage (OR = 2.67, 95% CI = 1.83-3.88), tumor stage (OR= 2.22, 95% CI= 1.34-3.66) and lymph node metastasis (OR = 3.07, 95% CI = 2.23-4.21). A shorter OS was significantly associated with the expression of LINC01296 (HR = 3.95, 95% CI = 2.65-5.25) and lymph node metastasis (HR = 2.39, 95% CI =1.16-3.63). The OS did not show significant association with gender (HR = 0.83, 95% CI = -0.63-2.30) and tumor stage (HR= 2.66, 95% CI= -0.22-5.54). Conclusion: In conclusion, the results of this meta-analysis suggest that the expression of LINC01296 might be considered as a potential biomarker in patients with cancer.     

Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis

BackgroundAdjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients.MethodsPubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I² statistic and publication bias was detected using standard error-based funnel plots.ResultsA total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03–1.08, P < 0.001; I² = 18.5%) and DFS (HR:1.06, 95% CI: 1.02–1.10, P = 0.001; I² = 40.6%).ConclusionThe initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely.     

Prognostic Value of Tissue Vascular Endothelial Growth FactorExpression in Bladder Cancer: a Meta-analysis

Objective: The prognostic role of vascular endothelial growth factor (VEGF) in bladder cancer remainscontroversial. This meta-analysis aimed to explore any association between overexpression and survival outcomes.Methods: We systematically searched for studies investigating the relationships between VEGF expression andoutcome of bladder cancer patients. Study quality was assessed using the Newcastle-Ottawa Scale. After carefulreview, survival data were extracted from eligible studies. A meta-analysis was performed to generate combinedhazard ratios (HRs) for overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS).Results: A total of 1,285 patients from 11 studies were included in the analysis. Our results showed that tissueVEGF overexpression in patients with bladder cancer was associated with poor prognosis in terms of OS (HR,1.843; 95% CI, 1.231-2.759; P = 0.003), DFS (HR, 1.498; 95% CI, 1.255-1.787; P = 0.000) and DSS (HR, 1.562;95% CI, 0.996-1.00; P = 0.052), though the difference for DSS was not statistically significant. In addition, therewas no evidence of publication bias as suggested by Begg’s and Egger’s tests except for DFS (Begg’s test, P =0.221; Egger’s test, P = 0.018). Conclusion: The present meta-analysis indicated elevated VEGF expression tobe associated with a poor prognosis in patients with bladder cancer.     

Impact of vascular endothelial growth factor expression on overall survival in patients with osteosarcoma: a meta-analysis

Osteosarcoma is the most common primary malignant bone tumor of childhood. Vascular endothelial growth factor (VEGF) expression has been implicated in tumor development and progression of osteosarcoma, but previous studies investigating the impact of VEGF expression on overall survival in patients with osteosarcoma report conflicting findings. A meta-analysis of published studies was performed. The pooled hazard ratio (HR) with its 95 % confidence interval (95 % CI) was used to assess the impact of VEGF expression on overall survival in patients with osteosarcoma. Nine studies with a total of 432 osteosarcoma patients were included into this meta-analysis. There was no between-study heterogeneity among those nine studies (I ²?=?0.0 %). Overall, high VEGF expression was obviously associated with poorer overall survival (HR?=?1.68, 95 % CI 1.33–2.12, P?<?0.001). Sensitivity analysis performed by excluding single study in turns showed the pooled estimate was stable. Egger’s test also did not suggest evidence for publication bias (P?=?0.216). Therefore, this meta-analysis suggests that VEGF expression has an important impact on overall survival in patients with osteosarcoma and high VEGF expression is associated with poorer overall survival.     

Partial hepatectomy vs. transcatheter arterial chemoembolization for multiple hepatocellular carcinomas of BCLC-B stage: A meta-analysis of high-quality studies

Background/aimThe Barcelona Clinic Liver Cancer (BCLC) recommends that transcatheter arterial chemoembolization (TACE) are indicated in patients with multiple hepatocellular carcinomas (HCCs) of BCLC-B stage. However, partial hepatectomy (PH) has increasely performed in these patients. The purpose of this meta-analyses is to illustrate the comparative survival benefits of PH and TACE for patients with multiple HCCs of BCLC-B stage.MethodElectronic databases were systematically searched for eligible studies that compared PH and TACE performed in patients with multiple HCCs of BCLC-B stage. Studies that met the inclusion criteria were reviewed systematically. The reported data were aggregated statistically using the RevMan5.3 software. Primary endpoint was overall survival (OS), and secondary endpoint were the 1-, 3-, and 5-year survival rates, postoperative 30-day mortality and postoperative complications.ResultsA total of seven high-quality studies (one randomized controlled trial [RCT], six propensity-score matching (PSM) nonrandomized comparative trials [non-RCTs] that met the inclusion criteria, which comprised of 2487 patients (1245 PH and 1242 TACE) in the meta-analysis. When compared with the TACE group, the PH group had a significantly higher OS (HR, 1.65; 95% CI, 1.48–1.84; P = 0.26; I² = 22%) and 1-, 3-, 5-year survival rates (OR, 1.96; 95% CI, 1.59–2.41; P = 0.0005; I² = 75%; P < 0.00001; OR, 2.92; 95% CI, 1.94–4.42; P = 0.0001; I² = 78%; P < 0.00001; OR, 2.60; 95% CI, 2.17–3.11; P = 0.13; I² = 44%; P < 0.00001; respectively). Survival benefits persisted across sensitivity and subgroup analyses; High heterogeneity remained after sensitivity and subgroup analyses for 3-year survival rates.ConclusionPH can provide more survival benefit for patients with multiple HCCs of BCLC-B stage compared with TACE.     

The Role of the PTEN/PI3K/Akt Pathway on Prognosis in Epithelial Ovarian Cancer: A Meta‐Analysis

Introduction.

The PTEN/PI3K/Akt signaling pathway, a key player in mediating apoptosis, metabolism, cell proliferation, and cell growth, is frequently dysregulated in many cancers. However, the pathway’s prognostic impact in epithelial ovarian cancer (EOC) is still inconsistent. We performed a meta-analysis based on individual study outcomes to more precisely evaluate its clinical significance in EOC patients.

Methods.

We searched all potentially relevant studies published between January 1, 1990, and March 1, 2013, that assessed the association between PTEN, PI3K, and Akt status and survival in EOC. Meta-analysis was performed using a fixed-effect or random-effects model as appropriate. We investigated the possibility of publication bias through a funnel plot and identified the heterogeneity by I² statistics.

Results.

Eleven eligible studies were analyzed for PTEN, 5 for PI3K, and 11 for pAkt. High PI3K and pAkt expression was associated with poor overall survival (OS; pooled adjusted hazard ratio [HR] = 1.44, 95% CI, 1.08–1.91 for PI3K; HR = 1.60, 95% CI, 1.26–2.04 for pAkt). In addition, both the meta-analyses of univariate and multivariate estimates showed that only high pAkt expression was significantly associated with poor progression-free survival (PFS; pooled unadjusted HR = 1.24, 95% CI, 1.10–1.39; pooled adjusted HR = 1.65, 95% CI, 1.07–2.55).

Conclusion.

Published studies suggest that high pAkt expression is significantly associated with poor OS and PFS in EOC patients, but currently available evidence is insufficient to recommend that PTEN, PI3K, or Akt be used as prognostic predictors in EOC in clinical practice.     

Meta-analysis of molecular targetted agents in the treatment of elderly patients with metastatic colorectal cancer: does the age matter?

Aim: Patients aged 65?years and older are often under-represented in clinical trials of metastatic colorectal cancer (mCRC) and probably undertreated in clinical practice. We performed a meta-analysis of randomized controlled trials to assess the efficacy of molecular targetted agents (MTAs) in this population.

Methods: A comprehensive literature search for studies published up to December 2014 was performed. The endpoints were overall survival (OS) and progression-free survival (PFS). The pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials.

Results: Eleven randomized controlled trials involved 8,488 patients were ultimately identified. The pooled analysis demonstrated that the use of MTAs in elderly patients with mCRC significantly improved OS (HR 0.84, 95% CI: 0.76–0.92, p?p?=?0.017) when compared to MTAs-free therapies. Similar results of OS were observed in sub-group analysis according to treatment line and regimes. No publication bias was detected by Begg's and Egger's tests.

Conclusions: The introduction of MTAs to therapies offers a survival benefit in elderly patients with mCRC. Further studies aimed at this specific patient population are still needed to monitor potential treatment-related toxicities to optimize the use of these drugs.