雌激素受体β与结直肠癌临床病理特征及预后关系的Meta分析

目的通过Meta分析来评价雌激素受体β表达与结直肠癌临床病理特征及预后的关系,为雌激素受体β在结直肠癌诊断和治疗中的作用提供循证医学证据。 方法检索中国知网、万方、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,检索建库开始至2019年12月所有研究雌激素受体β与结直肠癌的文献,提取相关临床资料和数据,根据纳入和排除标准,并根据Cochrane文献质量评估手册评估文献质量,最后采用RevMan 5.3进行Meta分析。 结果最终8篇文献2 149例患者纳入分析。雌激素受体β表达阳性患者预后更好,差异有统计学意义（HR=0.74,95% CI：0.63~0.86,P=0.000 1）。雌激素受体β表达与肿瘤的浸润程度有关,差异有统计学意义（OR=1.44,95% CI：1.15~1.80,P=0.002）,而与性别（OR=1.17,95% CI：0.97~1.40,P=0.10）、肿瘤的分化程度（OR=0.96,95% CI：0.78~1.20,P=0.74）、淋巴结转移（OR=0.90,95% CI：0.74~1.11,P=0.33）、远处转移（OR=0.91,95% CI：0.67~1.23,P=0.55）等无关,差异无统计学意义。 结论雌激素受体β是结直肠癌的独立预后因子,在结直肠癌预后评估和治疗靶点方面具有重要作用。     

长链非编码RNA牛磺酸调节基因1和miR-132的表达与乳腺癌预后的关系

目的探讨乳腺癌中长链非编码RNA（LncRNA）牛磺酸调节基因（TUG）1和miR-132表达情况及两者表达水平与患者预后的关系。 方法收集2014年1月至2017年11月如皋市人民医院90例手术切除的乳腺癌组织和相应癌旁组织,采用qRT-PCR法检测TUG1和miR-132表达水平,使用Kaplan-Meier法计算TUG1和miR-132表达对乳腺癌患者生存率的影响,采用Cox回归模型分析乳腺癌预后的影响因素。 结果与癌旁组织相比,乳腺癌组织中TUG1表达水平明显升高（t=65.781,P<0.001）,miR-132表达水平显著下降（t=33.089,P<0.001）,均与雌激素受体（ER）、人表皮生长因子受体2（HER-2）、FIGO分期、分化程度和淋巴结转移相关（均P<0.05）。乳腺癌组织中TUG1和miR-132表达之间呈负相关关系（r=-0.767,P=0.025）。TUG1高表达者3年生存率为80.77%（42/52）,显著低于低表达者97.37%（37/38）（χ²=5.639,P=0.018）;miR-132低表达者3年生存率为81.25%（39/48）,显著低于高表达者95.24%（40/42）（χ²=4.085,P=0.043）。Cox回归分析发现,ER、HER-2、FIGO分期、分化程度、淋巴结转移、TUG1和miR-132均是乳腺癌患者预后的影响因素（均P<0.05）。 结论在乳腺癌组织中,TUG1表达水平显著上调,miR-132表达水平显著下调,且两者呈负相关,都是影响预后的独立因素。TUG1可能通过调控miR-132的表达发挥促癌基因的作用,有望成为乳腺癌独立预后标志物和治疗新靶点。     

替吉奥联合奥沙利铂对比替吉奥联合顺铂治疗晚期胃癌的Meta分析

目的评价替吉奥联合奥沙利铂（SOX方案）对比替吉奥联合顺铂（SP方案）治疗晚期胃癌（AGC）的疗效及安全性。 方法在PubMed、Embase、Web of Science、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库、维普中文科技期刊数据库中检索2022年7月前公开发表的有关替吉奥联合奥沙利铂（SOX组）对比替吉奥联合顺铂（SP组）治疗AGC的相关研究,按照Cochrane Handbook 5.1的临床试验质量评价标准对文献进行质量评价,采用RevMan 5.4软件进行Meta分析。 结果共有14篇2 650例AGC患者纳入研究,其中SOX组1 334例,SP组1 316例。与SP组比较,SOX组的总生存期（HR=0.87,95% CI：0.78~0.97,P=0.01）、无进展生存期（HR=0.87,95% CI：0.78~0.97,P=0.01）、完全缓解（OR=1.43,95% CI：1.02~2.00,P=0.04）、部分缓解（OR=1.64,95% CI：1.18~2.29,P=0.003）、疾病进展（OR=0.55,95% CI：0.34~0.87,P=0.01）、疾病控制率（OR=1.64,95% CI：1.04~2.56,P=0.03）和疾病稳定（OR=0.67,95% CI：0.53~0.83,P=0.000 4）方面比较,差异均有统计学意义,而两组客观有效率差异无统计学意义（OR=1.57,95% CI：0.85~2.90,P=0.15）。安全性方面,3级及以上不良反应中,SOX组白细胞减少（OR=0.20,95% CI：0.13~0.30,P<0.000 01）、贫血（OR=0.52,95% CI：0.32~0.86,P=0.01）、肌酐升高（OR=0.21,95% CI：0.07~0.61,P=0.004）的发生率更低,而周围感觉神经病（OR=10.64,95% CI：1.85~61.10,P=0.008）的发生率更高。 结论SOX方案可提高AGC的治疗有效率,改善无进展生存期和总生存期,但可能增加周围感觉神经病的发生率。     

加速康复外科理念在肝移植围术期应用效果的Meta分析

背景与目的：加速康复外科（ERAS）是一种多学科合作模式,其已被证实在多学科应用安全有效,但ERAS理论在肝移植领域仍处于探索阶段。本研究旨在系统评价ERAS在肝移植患者围术期的应用效果。 方法：利用PubMed、Cochrane、Embase、CNKI、维普和万方及临床试验注册平台和灰色文献数据库检索相关文献,检索时间为建库至2020年7月8号。由2名研究者独立筛选文献、提取资料并评价偏倚风险后,应用Stata 16.0进行Meta分析。 结果：最终纳入21篇文献,共2 136例患者,其中1 008例患者接受ERAS干预（ERAS组）,1 128例行传统围手术期管理（传统组）;随机对照试验研究13篇,临床对照试验研究8篇。Meta分析结果显示,与传统组比较,ERAS组术后总并发症发生率（OR=0.31,95% CI=0.22~0.43,P<0.001）以及排斥反应（OR=0.26,95% CI=0.13~0.53,P<0.001）、胸腔积液（OR=0.31,95% CI=0.17~0.57,P<0.001）、胆汁漏（OR=0.19,95% CI=0.05~0.65,P=0.008）、感染（OR=0.28,95% CI=0.16~0.50,P<0.001）和肺部感染（OR=0.53,95% CI=0.33~0.86,P=0.010）并发症发生率均明显降低;住院时间（WMD=-5.76,95% CI=-6.89~-4.63,P<0.001）、ICU治疗时间（WMD=-2.26,95% CI=-3.21~-1.31,P<0.001）、手术时间（WMD=-41.07,95% CI=-67.82~-14.32,P=0.003）和无肝期（WMD=-5.78,95% CI=-11.50~-0.07,P=0.047）均明显缩短,术中失血量（WMD=-794.67,95% CI=-1 302.96~-286.39,P=0.002）明显减少,患者满意度明显提高。 结论：ERAS在肝移植术围术期应用安全有效,可促进患者术后康复。     

选择性脾动脉栓塞术与传统开腹手术治疗外伤性脾破裂安全性和有效性的Meta分析

目的比较选择性脾动脉栓塞术（PSAE）与传统开腹手术（OS）治疗外伤性脾破裂的临床疗效。 方法检索中国知网、万方数据、维普数据库、PubMed、Web of Science、Embase数据库中关于PSAE和OS两种手术方式治疗外伤性脾破裂的相关文献，检索时间为建库至2022年5月31日。提取文献内数据，采用RevMan 5.3软件进行Meta分析。 结果最终纳入16篇文献共5 238例患者，其中PSAE组1 037例，OS组4 201例。Meta分析显示：相较于OS组，PSAE组术中出血量更少（WMD= -392.95，95% CI：-667.52，-118.38；P=0.005），术中输血量更少（WMD=-433.87，95% CI：-582.85，-284.89；P<0.000 01），手术时间更短（WMD=-60.25，95% CI：-71.99，-48.52；P<0.000 01），抢救成功率更高（WMD=4.00，95% CI：1.32，12.09；P=0.01），且PSAE组术后下床时间（WMD=-14.44，95% CI：-20.32，-8.55；P<0.000 01）和住院时间（WMD=-4.89，95% CI：-5.86，-3.91；P<0.000 01）更短；术后并发症发生率方面，PSAE组术后切口感染（OR=0.21，95% CI：0.11，0.37；P<0.000 01）、肠梗阻（OR=0.24，95% CI：0.10，0.55；P=0.000 8）、肺炎（OR=0.44，95% CI：0.32，0.61；P<0.000 01）的发生率均低于OS组，但两组术后脾脓肿、发热、腹腔积液的比较，差异无统计学意义；术后免疫功能恢复方面，PSAE组术后1个月的CD3⁺水平（WMD=9.27，95% CI：6.32，12.22；P<0.000 01）、CD4⁺水平（WMD=5.60，95% CI：3.86，7.34；P<0.000 01）、CD4⁺/CD8⁺值（WMD=0.35，95% CI：0.18，0.52；P<0.000 01）均高于OS组，但OS组术后1个月的CD8⁺水平高于PSAE组（WMD=-1.20，95% CI：-1.72，-0.68；P<0.000 01）。 结论在外伤性脾破裂患者的诊治中，PSAE较OS有其独到优势，具有操作简单、手术时间短、术中出血量少、术后并发症少、住院时间短、术后免疫功能恢复早等优势，值得临床选用。     

lncRNA NEAT1与消化系统恶性肿瘤预后及临床病理特征关系的Meta分析

背景与目的 长链非编码RNA核富集转录本1（lncRNA NEAT1）在多种实体肿瘤中表达失调并与不良预后密切相关,但其与消化系统恶性肿瘤患者预后之间关系仍不明确。因此,本研究通过系统评价及Meta分析探讨lncRNA NEAT1对消化系统恶性肿瘤患者预后的影响及其与临床病理特征之间的关系。方法 在线检索PubMed、Web of Science、Cochrane Library、中国知网和万方数据库,检索时间均从建库至2021年10月18日,收集公开发表的关于lncRNA NEAT1表达与消化系统恶性肿瘤患者预后或临床病理特征之间关系的队列研究,由2名研究者根据纳入和排除标准对文献进行筛选并提取相关数据,采用Stata 12.0软件进行统计学分析。结果 最终共纳入20项研究,2 031例消化系统恶性肿瘤患者。纳入研究的NOS评分均在6~9分之间,其中16项研究报道了总体生存率（OS）,5项研究报道了无病生存率（DFS）,19项研究报道了临床病理学特征。Meta分析结果显示：NEAT1高表达的消化系统恶性肿瘤患者OS（HR=1.66,95% CI=1.41~1.97,P<0.001）和DFS（HR=2.0,95% CI=1.51~2.65,P<0.001）均低于NEAT1低表达或不表达患者。根据生存分析方法、NEAT1表达截取值、样本量和随访时间进行亚组分析结果显示,NEAT1高表达患者的OS均明显降低（均P<0.05）。此外,临床病理特征分析结果显示：较高水平的NEAT1患者的肿瘤直径更大（OR=2.20,95% CI=1.73~2.79,P<0.001）、临床分期更晚（OR=3.10,95% CI=1.95~4.92,P<0.001）、淋巴结转移（OR=1.94,95% CI=1.30~2.90,P=0.001）及远处转移的风险更高（OR=2.58,95% CI=1.88~3.54,P<0.001）,其与患者年龄、性别、肿瘤分化程度及脉管浸润之间无明显关系（均P>0.05）。结论 lncRNA NEAT1高表达是消化系统恶性肿瘤的不利预后因素,且与不良临床病理特征密切相关,有望作为消化系统恶性肿瘤病情监测及预后判断的重要参考指标。     

细胞间黏附分子复合体表达与胃癌侵袭转移及预后的关系

目的探讨细胞间黏附分子复合体表达与胃癌侵袭转移及预后的关系。方法应用免疫组化SP法,检测胃癌组织与非肿瘤胃黏膜组织中的Syndecan-1、E钙粘素（E-cadherin）与整合素β3（integrin-β3）的表达。结果本组118例胃癌组织中Syndecan-1、E-cadherin的表达明显低于20例非肿瘤胃黏膜组织（P=0.000、P=0.000）,其表达水平与肿瘤的浸润深度（P=0.000、P= 0.000）、脉管侵犯（P=0.000、P=0.000）、淋巴结转移（P=0.000、P=0.000）和远处转移（P=0.000、P=0.000）呈显著负相关;而integrin-β3的表达明显高于非肿瘤胃黏膜组织（P=0.000）,其表达水平与肿瘤的浸润深度（P=0.000）、脉管侵犯（P=0.000）、淋巴结转移（P=0.000）和远处转移（P= 0.000）呈显著正相关。三种蛋白的表达均与胃癌的生长方式相关（P=0.000、P=0.000、P=0.015）,而与分化程度无关（P=0.063、P=0.138、P=0.585）。Syndecan-1与E-cadherin两种蛋白表达水平呈显著正相关（P=0.000）,二者与integrin-β3的表达水平均呈显著负相关（P=0.000、P=0.000）。单因素分析显示,Syndecan-1、E-cadherin蛋白低表达及integrin-β3白高表达患者的5年生存率均低于Syndecan-1、E-cadherin蛋白高表达及integrin-β3白低表达的患者（分别为12.8%及91.7%,P= 0.000;12.8%及93.6%,P=0.000;13.9%及72.8%,P=0.000）。COX模型多因素分析显示,Syndecan-1的表达水平可作为独立于胃癌生长方式、浸润深度、脉管侵犯、淋巴结转移和远处转移等指标外的胃癌预后指标（P=0.000）,而E-cadherin与integrin-β3能作为反映胃癌预后的独立指标（P=0.978、P=0.789）。结论Syndecan-1、E-cadherin蛋白低表达及integrin-β3蛋白高表达均与胃癌的侵袭与转移显著相关,可作为胃癌预后判断的重要指标。     

一期手术与二期手术治疗先天性巨结肠的Meta分析

目的比较一期手术和二期手术治疗先天性巨结肠（HD）的术后并发症及排便功能。 方法通过检索Pubmed、Web of Science、中国知网、万方中文数据库，筛选出2018年6月之前发表的符合标准的一期手术与二期手术治疗HD的对比研究。应用STATA 14.0软件对纳入文献的相关数据进行Meta分析，同时对纳入文献进行发表偏倚检验及敏感性分析。 结果共筛选出10篇文献633例患者，包括9篇英文和1篇中文回顾性对比研究。Meta分析结果显示：在术后并发症方面，一期手术组与二期手术组在吻合口狭窄（OR=0.56，95% CI：0.29~1.09，P=0.087）、吻合口瘘（OR=1.01，95% CI：0.16~6.51，P=0.995）、肠梗阻（OR=0.88，95% CI：0.44~1.75，P=0.708）、直肠脱垂（OR=1.29，95% CI：0.35~4.82，P=0.705）、手术部位感染（OR=0.61，95% CI：0.31~1.20，P=0.152）、再次手术（OR=1.19，95% CI：0.66~2.16，P=0.563）的发生率比较，差异均无统计学意义，而二期手术组的术后小肠结肠炎（HAEC）发生率明显低于一期手术组（OR=2.09，95% CI：1.34~3.25，P=0.001）。在排便功能方面，两组术后排便功能良好率（OR=1.08，95% CI：0.58~2.01，P=0.804）、污粪（OR=0.60，95% CI：0.26~1.42，P=0.249）和大便失禁（OR=0.52，95% CI：0.17~1.55，P=0.237）的发生率比较，差异均无统计学意义，但一期手术组术后便秘发生率显著低于二期手术组（OR=0.49，95% CI：0.30~0.81，P=0.006）。 结论一期手术治疗HD避免了二期手术相关的吻合口并发症，而且便秘的发生率明显低于二期手术，但是HAEC发生率明显高于二期手术。     

lncRNA TUG1在儿童肝母细胞瘤中的表达及其与miR-204介导的JAK2-STAT3通路关系

背景与目的:近年来,儿童肝母细胞瘤(HB)的治疗方面取得一定的进步,但整体临床预后仍然较差,因此探索其发病机制和有效治疗靶点具有重要意义。本研究探讨长链非编码RNA(lncRNA)牛磺酸上调基因1(TUG1)与JAK2-STAT3通路相关分子在HB组织中的表达,初步分析HB中TUG1与miR-204介导的JAK2-STAT3血管生成信号通路之间的关系。方法:选取2017年3月—2018年4月湖南省儿童医院收治的60例HB患儿为研究对象,收集所有患儿HB肿瘤组织及其远端瘤旁正常组织,分别采用免疫组化与Western blot法检测组织中JAK2、STAT3及下游血管生成相关分子蛋白的表达,用qRT-PCR法检测组织中TUG1、miR-204与JAK2、STAT3及下游血管生成相关分子的RNA表达,并分析HB组织中TUG1与miR-204的表达的相关性。此外,在人HB细胞系HepG2中,观察TUG1敲减或miR-204过表达后,JAK2、STAT3及下游血管生成相关分子的RNA表达的变化。结果:免疫组化结果显示,HB组织中JAK2与STAT3蛋白的阳性表达率明显高于瘤旁正常组织(JAK2:40.1% vs.16.9%;STAT3:55.7% vs.19.8%,均P0.05)。qRT-PCR结果显示,HB组织中TUG1、JAK2、STAT3及血管生成相关分子VEGF、VEGFR2、HIF-1α的RNA表达均较瘤旁组织明显上调(均P0.05);HB组织中,TUG1与miR-204的表达呈明显负相关(r=-0.962,P=0.014)。Western blot结果显示,HB组织中JAK2、STAT3及下游血管生成相关分子的蛋白表达均较瘤旁组织明显上调(均P0.05)。HepG2中,TUG1敲减或miR-204过表达后,JAK2、STAT3及下游血管生成相关分子的RNA与蛋白表达均明显下调(均P0.05)。结论:HB患儿肿瘤组织内TUG1的表达上调,并伴有JAK2-STAT3通路的活性升高,且TUG1与miR-204的表达呈负相关,这提示在HB中,TUG1可能通过抑制miR-204表达,从而激活JAK2-STAT3通路,促进HB的血管生成。     

43例骨肉瘤患者预后的多因素分析

目的：探讨影响骨肉瘤患者预后的相关因素。方法：回顾性分析2005年3月至2007年3月手术治疗并经病理证实的43例骨肉瘤患者的临床资料,包括性别、年龄、部位、病程、化疗前血清碱性磷酸酶水平、术前化疗、En-neking分期、手术方式及远处转移情况等9项相关因素,采用Kaplan-Meier法计算生存率,应用Log-rank检验行单因素分析,COX检验行多因素分析,研究这些因素与骨肉瘤患者3年生存率之间的关系。采用精确概率Fisher检验研究化疗疗效对骨肉瘤患者预后的影响。结果：43例均获随访,28例存活,15例死亡,生存时间6～65个月,平均39.7个月,中位生存时间42个月,3年总生存率65.1%。单因素分析显示,骨肉瘤预后与部位（P=0.010）、Enneking分期（P=0.002）、手术方式（P=0.000）、远处转移（P=0.002）有相关性;COX多因素分析显示Enneking分期（P=0.028）、手术方式（P=0.001）及远处转移（P=0.007）是影响骨肉瘤患者预后的独立因素。Fisher精确检验显示,尽管术前是否行新辅助化疗对预后影响不明显,但是新辅助化疗疗效的好坏是患者预后的重要影响因素（P=0.007）。结论：骨肉瘤预后与En-neking分期、手术方式及远处转移密切相关,早期发现及充分切除肿瘤是提高骨肉瘤预后可干预措施。     

Whether histologic subtyping affect the oncological outcomes of patients with papillary renal cell carcinoma: evidence from a systematic review and meta-analysis

BackgroundWhether the histologic subtype (type 1 and type 2) of papillary renal cell carcinoma (pRCC) is a tool to predict the prognosis is of great debate. This study is aimed to evaluate the prognostic significance of histologic subtype in patients with pRCC after surgery through a systematic review and meta-analysis.MethodsWe searched PubMed, the Web of Science, Cochrane library and EMBASE databases to identify studies published until January 20, 2021 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were deemed eligible if they compared the overall survival (OS), cancer specific survival (CSS), recurrence-free survival (RFS) or disease-free survival (DFS) between patients with type 1 or type 2 pRCC. And the corresponding hazard ratios (HRs) and 95% conference intervals (CIs) were collected for meta-analysis and further subgroup analysis.ResultsOverall 22 studies with a total of 4,494 patients were considered eligible and included for the systematic review and meta-analysis. The pooled results showed that type 2 pRCC was associated with a worse OS (pooled HR 1.61, 95% CI: 1.10–2.36, P=0.02) and CSS (pooled HR 1.59, 95% CI: 1.00–2.51, P=0.05). However, the subgroup analysis yielded the same result as the initial analysis only when the HRs were extracted from univariate analysis. In studies with multivariate analysis, type 2 pRCC was not statistically associated with a worse OS (pooled HR 1.22, 95% CI: 0.97–1.53, P=0.27), CSS (pooled HR 1.16, 95% CI: 0.67–2.00, P=0.60), and DFS (pooled HR 1.33, 95% CI: 0.93–1.91, P=0.12) compared to type 1 pRCC.DiscussionHistologic subtype is not an independent prognostic factor for patients with pRCC, although the result needs to be taken with caution. And studies with retrospective study design, larger sample size and longer follow-up period are required to verify these results.     

Utility of cell-cycle modulators to predict vascular invasion and recurrence after surgical treatment of hepatocellular carcinoma

BACKGROUND: The outcome of surgical treatment of hepatocellular carcinoma (HCC) could be improved by applying patient selection criteria based on tumoral aggressiveness. Here we analyzed the prognostic role of the expression of several genes involved in cell-cycle regulation in a group of patients with HCC. METHODS: We retrospectively studied 93 patients (67 transplanted and 26 resections) treated between 1996 and 2000. In micro-thick sections from paraffin-embedded tumoral tissues, the expression of p53, pRb, p16, and cyclin D1 was analyzed. A logistic regression model was used to detect factors related to vascular invasion. A Cox regression model was applied to identify pathologic and molecular factors with the capacity to predict the recurrence of HCC. RESULTS: Only tumor size>3 cm (odds ratio [OR]: 3.4; 95% CI: 1.2-9.9; P=0.019) and pRb expression (OR: 4.1; 95% CI: 1.02-17; P=0.053) were associated with an increased risk of vascular invasion. The regression model applied to the group of transplanted patients showed three factors that were independently related to recurrence: vascular invasion (OR 7.5; 95% CI: 1.1-51.8; P=0.039); pRb expression (OR: 11; 95% CI: 1.2-96.9; P=0.03); and p16 expression (OR: 69.7; 95% CI: 5.1-9448; P=0.001). In the group of resected patients, pRb expression was associated with higher risk of recurrence only in the univariate analysis (P=0.037). The multivariate analysis showed tumor size>3 cm (OR: 57.5; 95% CI: 1.1-51.8; P=0.039) and vascular invasion (OR: 6.1; 95% CI: 1.05-35.3; P=0.044) to be significantly associated with recurrence. CONCLUSIONS: Of the molecular factors studied, only pRb expression was useful as a predictive factor of vascular invasion in patients with HCC, and also of recurrence in transplanted patients with this carcinoma. pRb expression may be relevant to consider when selecting patients for resection and when identifying transplanted patients with a high risk of recurrence.     

Prognostic value of preoperative blood-based biomarkers in upper tract urothelial carcinoma treated with nephroureterectomy: A systematic review and meta-analysis

Purpose: This systematic review and meta-analysis assessed the prognostic value of preoperative blood-based biomarkers in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy. Methods: PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in June 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in UTUC patients with and without pretreatment laboratory abnormalities. Formal meta-analyses were performed for this outcome. Results: The review identified 54 studies with 23,118 patients, of these, 52 studies with 22,513 patients were eligible for the meta-analysis. Several preoperative blood-based biomarkers were significantly associated with cancer-specific survival as follows: neutrophil-lymphocyte ratio (pooled hazard ratio [HR]: 1.66, 95% confidence interval [CI]: 1.34−2.06), C-reactive protein (pooled HR: 1.17, 95% CI: 1.07−1.29), platelet-lymphocyte ratio (pooled HR: 1.68, 95% CI: 1.30−2.17), white blood cell (pooled HR: 1.58, 95% CI: 1.02−2.46), De Ritis ratio (pooled HR: 2.40, 95% CI: 1.92−2.99), fibrinogen (pooled HR: 2.23, 95% CI: 1.86−2.68), albumin-globulin ratio (pooled HR: 3.00, 95% CI: 1.87−4.84), hemoglobin (pooled HR: 1.51, 95% CI: 1.22−1.87), and estimate glomerular filtration rate (pooled HR: 1.52, 95% CI: 1.19−1.94). The Cochrane's Q test and I² test revealed significant heterogeneity for neutrophil-lymphocyte ratio, C-reactive protein, white blood cell, hemoglobin, and estimated glomerular filtration rate (P = 0.022; I² = 50.7%, P = 0.000; I² = 80.4%, P = 0.000; I² = 88.3%, P = 0.010; I² = 62.0%, P = 0.000; I² = 83.9%, respectively). Conclusions: Several pretreatment laboratory abnormalities in patients with UTUC were associated with increased risks of cancer-specific mortality. Therefore, blood-based biomarkers may have the potential to serve as prognostic factors to assist patients and physicians in selecting appropriate treatment strategies for UTUC. However, considering the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.     

Prognostic value of pathologic fracture in patients with high grade localized osteosarcoma: A systemic review and meta‐analysis of cohort studies

Consensus has not been reached regarding the ability of pathologic fracture to predict local recurrence and survival in osteosarcoma. We aim to review the available evidence to examine the association between pathologic fracture and osteosarcoma prognosis. A comprehensive literature search for relevant studies published until March 2014 was performed using PubMed, Cochrane and Web of Science. The studies investigating pathologic fracture of osteosarcoma patients were systematically analyzed. The overall relative risk (RR) was estimated using a fixed‐effect model or random‐effect model according to heterogeneity between the trials. We included nine cohort studies involving 2,187 patients (311 with pathologic fracture and 1,876 without fracture) for the analysis of survival rate and local recurrence. Studies were assessed for quality using the Newcastle–Ottawa Assessment Scale. In the fixed‐effects model, the meta‐analysis showed that pathologic fracture in osteosarcoma patients predicted poor 3‐year overall survival (OS) (RR = 1.86, 95% CI: 1.37–2.53, p < 0.001) and 5‐year OS (RR = 1.34, 95% CI: 1.06–1.70, p = 0.016). Similarly, pathologic fracture was significantly correlated with worse 3‐year event free survival (EFS) (RR = 1.52, 95% CI: 1.21–1.92, p < 0.001) and 5‐year EFS (RR = 1.24, 95% CI: 1.03–1.49, p = 0.021), whereas no significant association was noted with local recurrence (RR = 1.30, 95% CI: 0.84–2.02, p = 0.233). The meta‐analysis confirmed that pathologic fracture in osteosarcoma was a prognostic marker for both OS and EFS but not for local recurrence. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:131–139, 2015.     

Prognostic value of FOXA1 in breast cancer: A systematic review and meta-analysis

BackgroundDespite some published papers analyzing the prognostic role of forkhead-box A1 (FOXA1) in breast cancer, it has not yet been considered as an established prognostic factor in clinical practice. The present meta-analysis evaluated the prognostic value of FOXA1 in breast cancer.MethodsPubMed, Web of Science and Embase databases were searched for relevant published literature that evaluated the correlation between FOXA1 and breast cancer. Either a fixed or random effect model was applied to estimate the pooled hazard ratio (HR) for FOXA1 prognosis in breast cancer.ResultA total of nine articles comprising 6386 breast cancer patients met the inclusion criteria. Among these nine studies, five studies and four studies investigated the prognostic association with disease-free survival (DFS), and overall survival (OS), respectively. Meta-analysis results suggested that high FOXA1 expression was positively associated with DFS (pooled HR: 0.43, 95% CI: 0.23–0.81; P < 0.05) and OS (pooled HR: 0.39, 95% CI: 0.26–0.60; P < 0.05) in breast cancer patients. No publication bias was discovered by Begg's test in this meta-analysis.ConclusionThe results from this meta-analysis indicated that elevated FOXA1 expression level was associated with better outcome in breast cancer.     

Smoking status and pathological response to neoadjuvant chemotherapy among patients with bladder cancer: a pooled analysis

BackgroundSmoking status has been confirmed as an independent prognostic factor for bladder cancer. However, for patients who received neoadjuvant chemotherapy (NAC), the influence of smoking status on the pathological response and prognosis remains unclear. This pooled analysis aimed to investigate whether smoking status is an independent risk factor for pathological response, recurrence, and prognosis in patients with bladder cancer who undergo NAC.MethodsWe searched PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar for related studies published between 1990 and 2017. In total, 10 studies comprising 1,382 patients with muscle-invasive bladder cancer were included. The odds ratio (OR) and 95% confidence interval (CI) of complete pathological response, partial pathological response, overall survive (OS), recurrence, and cancer-specific mortality (CSM) were chosen as outcome measures. Analyses were performed using Review Manager (version 5.3, The Cochrane Collaboration, UK) and Stata statistical software (version 15, Stata Corp., USA).ResultsCompared to nonsmokers, smokers were less likely to have a complete pathologic response (OR =0.55, 95% CI: 0.35–0.87) and partial pathological response (OR =0.57, 95% CI: 0.37–0.88). However, we found no significant association between smoking status and overall survival (OR =0.71, 95% CI: 0.28–1.80), recurrence (OR =1.35, 95% CI: 0.97–1.88), and cancer-specific mortality (OR =0.90, 95% CI: 0.62–1.32).ConclusionsSmoking reduces both complete and partial pathological response rate to NAC in patients with bladder cancer. Thus, smoking status should be given more importance when developing treatment plans and evaluating efficacy, particularly of NAC, among bladder cancer patients.