Neoadjuvant chemotherapy for primary resectable pancreatic cancer: a systematic review and meta-analysis

BackgroundPreoperative chemotherapy has shown benefits for locally advanced and borderline resectable pancreatic cancer. Neoadjuvant chemotherapy (NAC) has also been attempted in resectable pancreatic cancer (RPC); however, its role remains controversial. This study aimed to compare the clinical difference between NAC and upfront resection (UR) in RPC.MethodsElectronic databases including PubMed, Embase, Medline, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched for relevant articles from inception to February 2019 that addressed the overall survival in patients with RPC treated with or without NAC to identify eligible studies. Eleven studies were included in the final meta-analysis. The quality assessment of the included studies was based on the Newcastle–Ottawa quality scale. Data of the unresectable rate, R0 resection rate, and positive lymph node rate were also extracted in each study for further analysis. Pooled hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were calculated to assess the strength of the association.ResultsA total of eleven studies (eight cohort studies and three randomized controlled trials) involving 9773 patients were included. Ten of the eleven studies followed the “intention-to-treat” principle. NAC was found to be significantly associated with a higher R0 resection rate (P < 0.0001; OR = 2.62, 95% CI 1.70–4.03) and increased negative lymph node rate (P < 0.00001; OR = 0.34, 95% CI 0.31–0.37). However, compared with the UR group, NAC was related to a lower surgical resection rate (P = 0.0004; OR = 2.18, 95% CI 1.41–3.37). Overall, the NAC group exhibited no benefits in terms of overall survival compared with that in the UR group (P = 0.10; HR = 0.86, 95% CI 0.73–1.03). In the subgroup analysis, however, patients who received gemcitabine-based regimen as the NAC strategy had more favorable overall survival than that in the UR group (P = 0.04; HR = 0.75, 95% CI 0.57–0.99).ConclusionsNAC may be associated with a lower resection rate; however, it is associated with an increased R0 resection rate and lymph node negative rate. Although overall survival was similar in patients with or without NAC, gemcitabine-based NAC might provide longer overall survival. Further large-volume, randomized controlled trials are needed to validate the improved prognosis of patients undergoing NAC.     

The effect of concomitant chronic kidney disease on the recurrence of atrial fibrillation after catheter ablation: A protocol for systematic review and meta-analysis

Background:Some new trials have reported the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation. Limited by small number of studies and insufficient outcomes, previous meta-analyses also failed to draw a consistent conclusion on this topic. We thus conducted a new meta-analysis to systematically analyze the effect of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation.Methods:Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines to conduct the present meta-analysis. From the inception to June 2021, the EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases were searched using the key phrases “atrial fibrillation,” “chronic kidney disease,” “catheter ablation,” “renal failure,” “renal function,” “renal insufficiency,” “end-stage renal disease,” and “dialysis” for all relevant English-language trials. Observational or randomized controlled trial focusing on assessing the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation was included. P < .05 was set as the significance level.Results:Our hypothesis was that chronic kidney disease is associated with increased atrial fibrosis and a higher risk of arrhythmia recurrence and that restoration of normal rhythm through catheter ablation is associated with improved kidney function.Registration number:10.17605/OSF.IO/3WJAE.     

Bevacizumab combined with chemotherapy for ovarian cancer: A protocol for systematic review and meta-analysis

Background:The impact of bevacizumab (an anti-vascular endothelial growth factor therapy) remains uncertain, which has been the focus of studies on the management of ovarian cancer (OC). We performed a protocol for systematic review and meta-analysis to assess the efficacy and safety of bevacizumab combined with chemotherapy in OC.Methods:The presentation of methods and results in this systematic review was performed according to the evaluation guidelines for health care interventions provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. This study will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials Database. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting, and other bias by Cochrane Collaboration''s tool. All analyses were performed with Review Manager (RevMan) software, version 5.3.Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:Bevacizumab combined with chemotherapy may improve progression-free survival and overall survival in patients with OC.     

The association of statin use and biochemical recurrence after curative treatment for prostate cancer: A systematic review and meta-analysis

Objectives: To investigate the association between statin use and biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP) or radiotherapy (RT) as a curative treatment, a systematic review and meta-analysis was performed.Methods: We conducted a literature search of online databases for studies assessing BCR associated with statin use in patients with prostate cancer undergoing RP or RT. We performed a pooled analysis of BCR-free survival with subgroup analysis of treatment, cancer risk, and medication.Results: We identified 27 studies and found that statin use was associated with a potential tendency to improve BCR-free survival in patients undergoing curative treatment (P = .05). In addition, we revealed that statin use after curative treatment did not improve BCR-free survival (P = .33), whereas statin use could improve BCR-free survival in high-risk patients (P < .01).Conclusions: Statin use is associated with a potential tendency to improve BCR-free survival in prostate cancer and could reduce BCR in high-risk patients.     

Sequential or concomitant chemotherapy with hypofractionated radiotherapy for locally advanced non-small cell lung cancer: a meta-analysis of randomized trials

BackgroundFor patients with locally advanced non-small cell lung cancer (NSCLC), the standard treatment is concurrent or sequential chemotherapy with radiotherapy. Most treatment schedules use radiotherapy with conventional fractionation; however, the application of hypofractionated radiotherapy (HYPO-RT) regimens is rising. A meta-analysis was performed to assess the efficacy and safety of chemotherapy combined with HYPO-RT and indirectly compare with the outcomes from previous studies employing concomitant conventional radiotherapy (CONV-RT).MethodsRandomized controlled trials (RCTs) were identified on the electronic database sources through June 2020. Following the PRISMA guidelines, a meta-analysis was performed to assess if there were significant differences in the overall mortality (OM), local failure (LF), and disease progression (DP), comparing HYPO-RT-C vs. sequential chemotherapy followed HYPO-RT (HYPO-RT-S). To establish an indirect comparison with the current standard treatment, we calculate the risk ratio (RR) of the OM from RCTs using conventional chemoradiation, concurrent (CONV-RT-C), and sequential (CONV-RT-S), and compared with HYPO-RT. A P value <0.05 was considered significant.ResultsTwo RCTs with a total of 288 patients were included. The RR for the OM, DP and LF at 3 year comparing HYPO-RT-C vs. HYPO-RT-S were 1.09 (95% CI: 0.96–1.28, P=0.17), 1.06 (95% CI: 0.82–1.23, P=0.610), and 1.06 (95% CI: 0.86–1.29, P=0.490), respectively. The late grade 3 pneumonitis and esophagitis had no significant difference between HYPO-RT groups. In the indirect comparison of RCTs using CONV-RT, the RR for the OM at 3 years was 1.03 (95% CI: 0.96–1.10, P=0.36) with no significant difference for the HYPO-RT arms 1.09 (95% CI: 0.96–1.28, P=0.17).DiscussionHYPO-RT given with chemotherapy provides satisfactory OM, LF, and DP in locally advanced NSCLC with similar rates to the CONV-RT. These findings support HYPO-RT inclusion in future clinical trials as an experimental arm in addition to the incorporation of new strategies, such as immunotherapy.     

Adjuvant chemotherapy for resected biliary tract cancers: a systematic review and meta-analysis

Introduction

The use of adjuvant treatment (AT) in resected biliary tract cancers (BTC) is still controversial. No efficacy comparison has been performed between chemotherapy (CT) and chemoradiotherapy (CTRT). A systematic review of the available evidence regarding adjuvant chemotherapy (AC) in resected BTC was performed.

Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis

BACKGROUND: The benefit of neoadjuvant chemoradiotherapy in oesophageal cancer has been extensively studied but data on survival are still equivocal. OBJECTIVE: To assess the effectiveness of chemoradiotherapy followed by surgery in the reduction of mortality in patients with resectable oesophageal cancer. METHODS: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2002) were supplemented with hand searches of reference lists. STUDY SELECTION: Studies were included if they were randomised controlled trials (RCTs) comparing preoperative chemoradiotherapy plus surgery with surgery alone, and if they included patients with resectable histologically proven oesophageal cancer without metastatic disease. Six eligible RCTs were identified and included in the meta-analysis. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. RESULTS: Chemoradiotherapy plus surgery compared with surgery alone significantly reduced the three year mortality rate (odds ratio (OR) 0.53 (95% confidence interval (CI) 0.31-0.93); p = 0.03) (number needed to treat = 10). Pathological examination showed that preoperative chemoradiotherapy downstaged the tumour (that is, less advanced stage at pathological examination at the time of surgery) compared with surgery alone (OR 0.43 (95% CI 0.26-0.72); p = 0.001). The risk for postoperative mortality was higher in the chemoradiotherapy plus surgery group (OR 2.10 (95% CI 1.18-3.73); p = 0.01). CONCLUSIONS: In patients with resectable oesophageal cancer, chemoradiotherapy plus surgery significantly reduces three year mortality compared with surgery alone. However, postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy. Further large scale multicentre RCTs may prove useful to substantiate the benefit on overall survival.     

Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis

Purpose

The aim of this systematic review was to compare intracorporeal (IA) versus extracorporeal anastomosis (EA) after laparoscopic right hemicolectomy for cancer.

Methods

The meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Studies published from 2009 to 2012 that compare IA and EA after laparoscopic right hemicolectomy were identified. The included non-randomized studies were assessed for their methodological quality using the revised and modified grading system of the Scottish Intercollegiate Guidelines Network. Intraoperative, early postoperative, and postoperative recovery outcomes were compared using weighted mean differences and odds ratios.

Results

Five non-randomized controlled trials published between 2009 and 2011, comprising 425 patients, were included in this analysis. IA was associated with significant faster bowel movement, faster first flatus, shorter time to solid diet, decreased use of analgesics, and shorter duration of the hospital stay. No differences were observed for nasogastric tube reintroduction rate, operative time, incision length, number of nodes harvested, intraoperative complications, mortality, non-surgical site complications, surgical site complications (anastomotic leakage, anastomotic bleeding, wound infection, ileus), reintervention, and readmission rate.

Conclusions

Even when the limitations are taken into account due to the observational nature of the included studies, the results suggest that the IA after laparoscopic right hemicolectomy for cancer results in better postoperative recovery outcomes, such as shorter hospital stay, faster bowel movement recovery, faster first flatus, faster time to solid diet, and lesser analgesic usage.     

Effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer: A protocol for systematic review and meta-analysis

Background:Radiotherapy is one of the essential components of breast cancer treatment. It destroys the remaining cells in the chest area after breast cancer surgery and is useful for reducing the necessity of mastectomies. As a single dose of radiation at the time of breast conserving surgery, intraoperative radiotherapy delivers radiotherapy directly and accurately to the tumor itself or the tumor bed whilst delivering minimal dose to the surrounding normal tissues. Hypofractionated postmastectomy radiotherapy with shorter and more convenient hypofractionated dose schedules might help to treat more patients and reduce cost. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these 2 therapies in the management of early stage breast cancer.Methods:Four English databases (PubMed, Embase, Cochrane Library, and Web of Science) and 3 Chinese databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) will be searched from inception of databases to December 2020 without language limitation. Two reviewers will independently conduct selection of studies, data extraction and management, and assessment of risk of bias. Any disagreement will be resolved by the third reviewer. Review Manager 5.3 (The Cochrane Collaboration, Software Update, Oxford, UK) will be used for data synthesis. Cochrane risk of bias assessment tool will be used to assess the risk of bias.Results:This study will provide a systematic synthesis of current published data to compare the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer.Conclusions:This systematic review and meta-analysis will provide clinical evidence for the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer, and inform our understanding of the value of intraoperative radiotherapy and hypofractionated postmastectomy radiotherapy for early stage breast cancer.Study registration number:INPLASY2020110115.     

Effect of weight loss on recurrence of atrial fibrillation after ablative therapy: a systematic review and meta-analysis

Journal of Interventional Cardiac Electrophysiology - Landmark trials have shown superiority of ablative therapy over medical therapy in certain subpopulation with atrial fibrillation (AF)....     

Traditional Chinese medicine on treating myelosuppression after chemotherapy: A protocol for systematic review and meta-analysis

Background:Myelosuppression after chemotherapy is a common adverse reaction in the process of chemotherapy, mainly manifested as anemia, increased risk of bleeding, infection, the results seriously affect the quality of life and prognosis of patients, become the main cause of death. Since ancient times, traditional Chinese medicine (TCM) has been widely used in East Asia (such as China, Japan, South Korea) in the clinical treatment of bone marrow suppression after chemotherapy, which plays the role of synergism, toxicity reduction, immune regulation, and gradually developed into an indispensable role. Therefore, the purpose of this study was to use a network meta-analysis to evaluate the evidence that traditional Chinese medicine is related to the efficacy and safety of chemotherapy-induced myelosuppression.Methods:This study will search the following Chinese and English databases electronically: 4 Chinese literature databases, including China biology and medicine database, China National Knowledge Infrastructure, VIP, and Wan fang database, and 3 British literature databases including PubMed, EMBASE, and Cochrane Library. The search keywords were (traditional Chinese medicine or medicinal plants or extracts of traditional Chinese medicine or traditional Chinese medicine formula or preparation) and (myelosuppression after chemotherapy) and (randomized controlled trials) (RCTs). The search time limit is set to December 2020, and Chinese and English languages will be included. The included subjects must be diagnosed with myelosuppression after chemotherapy and RCTs should be conducted at the same time. The main outcome was elevated hemoglobin, platelets, leukocytes, and neutrophils. The secondary results were reticulocyte absolute value, reticulocyte percentage, low-fluorescence reticulocyte red, medium-fluorescent reticulocyte red, and high-fluorescence reticulocyte red. We will conduct a risk and quality assessment of the included studies using the Cochrane tool, and carefully calculate data synthesis after meta-analysis using Rev Man software (version 5.3.5) and R software (version 3.6.1).Results:The study is aim to evaluate the efficacy and safety of the treatment that traditional Chinese medicine for myelosuppression after chemotherapy.Conclusion:This study of the meta-analysis could provide evidence for clinicians and help patients to make a better choice.INPLASY registration number:INPLASY2020120097