Survival Rate of Colorectal Cancer in Iran: A Systematic Review and Meta-Analysis

Background: Different studies have been conducted to estimate the survival rate of colorectal cancer in Iran butthere is no overall estimate of the survival rate. The aim of this study was to calculate the pooled 1, 3, and 5-year survivalrate of the patients with colorectal cancer in Iran. Methods: To retrieve relevant studies, we conducted a systematicsearch in Iranian databases, including Iran Medex, Magiran, SID, and international databases such as Medlin/PubMed,Scopus, and Google scholar using “Colorectal Neoplasms” and “Survival Rate” as keywords up to December 1st, 2017.We used random effect model to estimate pooled 1, 3, and 5-year survival rates of the patients with colorectal cancerin Iran. To assess the heterogeneity, we used Chi-squared test at the 5 % significance level (p <0.05) and I2 Index. Weused meta-regression and subgroup analysis to find a potential source of heterogeneity. Results: After a systematicsearch, 196 articles were found, of the 38 studies met the eligibility criteria and are included in our meta-analysis. Thepooled 1, 3, and 5-year survival rates in patient with colorectal cancer were 0.84 (95% CI: 0.81-0.87), 0.64 (95%CI:0.59-0.70), and 0.54 (95%CI: 0.49-0.58) respectively. The 5-year survival rate in the subgroup of women was 0.5(0.44-0.56) and in male subgroup was 0.44 (0.40-0.48). In a subgroup of the tumor site, the 5-year survival rate in coloncancer was 0.6 (0.49-0.75) and rectum cancer was 0.54 (0.36-0.69). In multivariable models, there was a significantassociation between years of study and 5-year survival rate as a source of heterogeneity (β = 18.9, P=0.01). Conclusion:According to the results of this study, women had a better survival rate than men, and according to the tumor site, the5-year survival rate in colon cancer was better than the rectum cancer.     

Carbapenem-Resistant Klebsiella Pneumoniae in Iran: a Systematic Review and Meta-Analysis

The global emergence and dissemination of carbapenem-resistant (CR)-Klebsiella pneumoniae is an important healthcare concern owing to the limited therapeutic options that are available. The aim of the present study was to evaluate the prevalence of CR K. pneumoniae in different parts of Iran. A comprehensive literature search was performed in national and international databases. After applying predefined inclusion and exclusion criteria, 36 articles reporting prevalence of CR K. pneumoniae were collected. The pooled prevalence of CR K. pneumoniae was estimated to be 11.3% (95% CI: 0.084–0.15). The highest and lowest prevalence rates of CR K. pneumoniae were in Isfahan 58% (95% CI: 0.48-0.67) and Tehran 0.004 (95% CI: 0.00-0.05), respectively. The highest and lowest resistance rates were seen against aztreonam (55%, 95% CI: 0.48–0.62) and amikacin (23%, (95% CI: 0.17–0.29), respectively. The findings of the present study revealed that the prevalence of CR K. pneumoniae is alarmingly high in the majority of Iranian hospitals.     

Determining the Survival Rate of Colorectal Cancer in Iran: A Systematic Review and Meta-Analysis

Objective: Colorectal cancer is one of the most common causes of death in the world. Despite of remarkableadvances in medical sciences, cancer is an important disease and the second cause of death after cardiovascular diseases.The present study was aimed at determining the survival rate of colorectal cancer in Iran. Methods: The present studyis a systematic review of national and international electronic databases. Studies that had the inclusion criteria wereincluded in the study, electronically published articles over December 2007 and March 2015 were retrieved. The collecteddata were analyzed by meta-analytic method through stata 11.0 Software, and the survival rate was measured. Results:The 1-, 2-, 3-, 4-, and 5-year survival rates of colorectal cancer in Iran were respectively calculated as 85, 75.10, 65,55.40, and 52.The results indicated that there is a significant relationship between anatomic location of tumor andsurvival rate. According to the results of this examination, survival rate of the patients with rectal cancer was 41.9times higher than those with colorectal cancer. Conclusion: Due to the relative high prevalence of this cancer amongyoung people in Iran and the low survival rate, early diagnosis of colorectal neoplasms is necessary before they becomesymptomatic through more effective diagnosis programs of enhancing the patients’ health and survival rate. Moreover,it is necessary to conduct more specialized and relevant studies in order to determine genetic or environmental causes ofcancer such as diet and cultural and behavioral habits at the national level and with different ethnicities.     

Epidemiology of Oral Cancer in Iran: a Systematic Review

Background: Oral cancer stands among the 10 top causes of cancer death in the world. Considering the roleof epidemiologic information on planning and effective interventions, the present study aimed to investigatethe epidemiology of oral cancer in Iran. Materials and Methods: The required information for this systematicreview study was obtained from PubMed, Google Scholar, CINAHL,SID, Medlib, Magiran and Iranmedexdatabases, using key words “cancer”, “oral cancer”, “squamous cell carcinoma”, “oral cavity carcinoma” andtheir Persian equivalents in combination with keywords of epidemiology, prevalence, etiology, frequency, and Iranfrom 1990 to 2014. From 1,065 related studies found, finally 25 were included to the study. Results: The meanage of 8,248 patients in 25 studies was 54.0±15.1 years. The male/female ratio for oral cancer was 1.91. Tonguewith average percentage of 29.9 was the most involved site. Regarding microscopic grade, 65.7% of cases weregrade 1. SCCs, accounting for an average of 70.0%, was the most common among all types of oral cancer. In themajority of studies, smoking including cigarette, hookah, and tobacco consumption was found to be a risk factor.Conclusions: The epidemiological pattern of oral cancer in Iran is somewhat similar to that of other countries.Yet the information on hand in this field is limited and considering the role of epidemiological data we suggestconducting more accurate studies to catch data that is required for effective programs and interventions.     

Effect of Occupational Exposure to Radar Radiation on Cancer Risk: A Systematic Review and Meta-Analysis

Objective: Microwave radiation is one of the most growing environmental workplace factors that exposes too many workers in the various workplaces. Regard to concerns about cancer incidence in these workers and lack of systematic or meta-analytic studies about this object, so, we conducted a meta-analysis to acquire an understanding of the association between cancer risk and occupational exposure to radar radiation. Methods: A systematic search was carried out on case-control, cohort and clinical control trial studies that published in the Cochrane Library, PubMed, ISI Web of Science, Scopus and Google scholar databases that accomplished from March 2017 to March 2018 and updated on 30 September, 2018 in English and Persian articles without time limit in publication date. Keywords were selected based on PICO principle and collected from MeSH database. After removal of duplicated studied, taking into inclusion and exclusion criteria, the process of screening was carried out and data were extracted after preparation of the full text of included articles. Article collection was completed by manually searching for a reference list of eligible studies. For quality assessment of included studies, Newcastle-Ottawa scale was used. Results: a total of 533 studies was found in the first step of literature search, only 6 were included with 53,008 sample size according to inclusion and exclusion criteria. Estimated pooled random effects size analysis showed no significant increasing effect of occupational exposure to radar radiation on mortality rate (MR=0.81, 95%CI: 0.78, 0.83) and relative risk (RR=0.87, 95%CI: 0.75, 0.99, P <0.0001) of cancer with a significant heterogeneity between the selected studies. Conclusions: In conclusion, the results of this meta-analysis study have shown no significant increase in overall mortality ratio and cancer risk ratio from occupational exposure to the radar frequency of workers. But, these results are not conclusive. As regards to some limitation such as fewer numbers of included studies, lack of data about exposure characterizations and demographic characterizations in this meta-analysis, this result is not certain and conclusive. It is recommended to conduct future studies.     

The Association between Selenium and Prostate Cancer: a Systematic Review and Meta-Analysis

Background: Evidence of relationship between selenium and prostate cancer has been inconsistent. The present metaanalysis was conducted to determine relationship between selenium and prostate cancer. Methods: A systematic review and meta-analysis was carried out using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We searched PubMed, Scopus, Web of Science, ScienceDirect, Embase, CINAHL, Cochrane Library, EBSCO andGoogle scholar search engines and the reference lists of the retrieved papers for relevant data, without any limitationregarding language or time until 2016. Heterogeneity among studies was evaluated using Q test and I2 Index. Finally,a random effects model was used for combining results using STATA software version 11.1. Psignificant. Results: Thirty-eight studies including 36,419 cases and 105,293 controls were included in the final analysis. The pooled relative risk (RR) of relation between selenium and prostate cancer was 0.86 (95% Confidence Interval [CI]:0.78-0.94). Sub-group analyses based on case-control, cohort, and RCT studies gave values of 0.89 (95% CI:0.80-1.00), 0.77 (95% CI: 0.52-1.14) and 0.90 (95% CI: 0.74-1.09), respectively. RRs based on serum, plasma and nail samples were 0.69 (95% CI: 0.51-0.95), 0.85 (95% CI: 0.61-1.17), 0.66 (95% CI: 0.41-1.05), respectively. According to 10 studies, investigated the relation between advanced prostate cancer and selenium in which the RR was 0.67 (95% CI: 0.52-0.87). Conclusions: This meta-analysis indicated that selenium most probably has a protective role against development of prostate cancer and its progression to advanced stages. Therefore, selenium supplementation can be proposed for prevention of prostate cancer.     

Ki-67/MIB-1 as a Prognostic Marker in Cervical Cancer - a Systematic Review with Meta-Analysis

Background: In cervical cancer patients it has been reported that there in a significant Ki-67/MIB-1 expressionis correlated with survival in cervical cancer patients. However, the prognostic value is still not well understood.Materials and Methods: In the present meta-analysis the prognostic value of Ki-67/MIB-1 with regard to overallsurvival (OS) and disease-free survival (DFS) in cervical cancer was investigated. The databases of PubMed, ISIWeb of Science, Cochrane Central Register of Controlled Trials, EMBASE, Science Direct and Wiley OnlineLibrary were used to identify appropriate literature. Results: In order to explore the relationship between Ki-67/MIB-1 and cervical cancer, we have included 13 studies covering 894 patients in the current meta-analysis. Theeffect of Ki-67/MIB-1 on OS for pooled random effects HR estimate was 1.63 (95%confidence interval (CI) 1.09-2.45; P<0.05). The pooled HR for DFS was 1.26 (95%CI 0.58-2.73; P>0.05) and the subgroup analysis indicatedKi-67/MIB1 was associated with DFS (HR=3.67, 95%CI 2.65-5.09) in Asians. Conclusions: According to thismeta-analysis, Ki-67/MIB-1 has prognostic value for OS in patients suffering from cervical cancer. For betterevaluation of the prognostic role of Ki-67/MIB-1 on DFS, studies with larger numbers of patients are needed tovalidate present findings in the future.     

Cancer Screening Awareness and Practice in a Middle Income Country; A Systematic Review from Iran

Objective: Ageing population and noticeable changes in lifestyle in developing countries like Iran caused an increase in cancer incidence. This requires organized cancer prevention and screening programs in population level, but most importantly community should be aware of these programs and willing to use them. This study explored existing evidence on public awareness and practice, as well as, adherence to cancer screening in Iranian population. Methods: Major English databases including Web of Science, PubMed, Scopus, and domestic Persian databases i.e., SID, Magiran, and Barakat search engines were searched. All publications with focus on Iranian public awareness about cancer prevention, screening, and early detection programs which were published until August 2015, were explored in this systematic review. For this purpose, we used sensitive Persian phrases/key terms and English keywords which were extracted from medical subject headings (MeSH). Taking PRISMA guidelines into considerations eligible documents, were evaluated and abstracted by two separate reviewers. Results: We found 72 articles relevant to this topic. Screening tests were known to, or being utilized by only a limited number of Iranians. Most Iranian women relied on physical examination particularly self-examination, instead of taking mammogram, as the most standard test to find breast tumors. Less than half of the average-risk adult populations were familiar with colorectal cancer risk factors and its screening tests, and only very limited number of studies reported taking at least one time colonoscopy or FOBT, at most 5.0% and 15.0%, respectively. Around half of women were familiar with cervical cancer and Pap-smear test with less than 45% having completed at least one lifetime test. The lack of health insurance coverage was a barrier to participate in screening tests. Furthermore some people would not select to be screened only because they do not know how or where they can receive these services. Conclusion: Low awareness and suboptimal use of screening tests in Iran calls for effective programs to enhance intention and compliance to screening, improving the patient-physician communication, identifying barriers for screening and providing tailored public awareness and screening programs.     

Epidemiology of Primary CNS Tumors in Iran: A Systematic Review

Background: Although primary malignant CNS tumors are registered in the national cancer registry (NCR)of Iran, there are no available data on the incidence of the primary malignant or benign CNS tumors and theircommon histopathologies in the country. This study analyzed the 10-year data of the Iranian NCR from March21, 2000 to March 20, 2010, including a systematic review. Materials and Methods: The international and nationalscientific databases were searched using the search keywords CNS, tumor, malignancy, brain, spine, neoplasmand Iran. Results: Of the 1,086 primary results, 9 papers were selected and reviewed, along with analysis of10-year NCR data. The results showed that primary malignant brain tumors have an overall incidence of 2.74per 100,000 person-years. The analysis of the papers revealed a benign to malignant ratio of 1.07. The mostcommon histopathologies are meningioma, astrocytoma, glioblastoma and ependymoma. These tumors are morecommon in men (M/F=1.48). Primary malignant spinal cord tumors constitute 7.1% of the primary malignantCNS tumors with incidence of 0.21/100,000. Conclusions: This study shows that CNS tumors in Iran are incompliance with the pattern of CNS tumors in developing countries. The NCR must include benign lesions tounderstand the definitive epidemiology of primary CNS tumors in Iran.     

Preterm Birth and Breast Cancer Risk: A Systematic Review and Meta-Analysis

Backgrounds: Changes in estrogen levels during pregnancy as well as histologic changes in breast tissue can justify the relationship of preterm birth (PTB) and the risk of BC. Therefore, there is a hypothesis that the duration of pregnancy can be associated with BC, so the aim of this study was to find out whether PTB is a risk factor for BC. Methods: Published studies were located back to the earliest available publication date (1983), using the Medline/PubMed, Embase, Scopus, and Web of Science bibliographic databases. This review included the cohort or case control studies that assessed the association between PTB and BC. Pooled effect sizes with corresponding 95% confidence intervals (CI) were calculated using random-effects models. Results: Thirteen studies including a total of 2,845,553 women were included in this meta-analysis. Pooled results suggested that PTB could increase the risk of BC (RR: 1.03, 95% CI: 1.00, 1.07; I2= 62.5%). The risk was significantly increased in women who delivered at 37-39 (RR: 1.03, 95% CI: 1.01, 1.06) and 26-31 weeks of gestation (RR: 1.25, 95% CI: 1.04, 1.47) compared to women who delivered at 40-41 weeks of gestation. A significant increment in the risk of BC was observed in primiparous (RR: 1.05, 95% CI: 1.01, 1.08) and women older than 45 years (RR = 1.12, 95% CI: 1.01, 1.24). There was no difference between other gestational age categories. Conclusions: Our findings add to evidence that short gestation pregnancies may increase the risk of BC, especially in primiparous and women older than 45 years. Considering the methodological weaknesses existed in included studies, minor clinical differences, and the complexity of the exact pathophysiology of PTB on BC, the precise position of PTB as a risk factor for BC in clinical practice is undetermined. Further studies are still needed.     

Increasing Trend in Colorectal Cancer Incidence in the Southeast of Iran 2003-2013: A Population Based Cancer Registry Study

Rates based on age-adjusted incidence of colorectal cancers over a 10-year period in Kerman, the biggestprovince of Iran, were estimated from 2003 to 2013. Data were obtained from the population-based cancerregistry unit of Kerman University of Medical Sciences (CR-KMU). Information included age, sex, city, ICD-Oand year of registry. Our trend analyses cover 3.91% of the Iranian population. The data set comprised casesdiagnosed from 2003 to 2013.The population of over 20 years was interpolated using 2003 and 2010 censuses.Then, truncated age-adjusted incidence rates were calculated. Increase was noted from 2003-2009 to 2010-2013for 731 cancer cases considered in the analysis. The increases was most prominent in 2009. Totally, the frequencyof the cancer was greater in males. Moreover, calculating truncated age-adjusted incidence rate indicated thatthe most prevalent age of colorectal incidence was in the 50-59 year age group except in 2007-2008 and 2012-2013, when greatest incidences occurred in people aged 60-69 years. Our data revealed that the incidence ratesof colorectal cancer have increased over the past decade in our region of Iran.     

Prognostic Role of Hepatoma-derived Growth Factor in Solid Tumors of Eastern Asia: a Systematic Review and Meta-Analysis

Hepatoma-derived growth factor (HDGF) is a novel jack-of-all-trades in cancer. Here we quantify theprognostic impact of this biomarker and assess how consistent is its expression in solid tumors. A comprehensivesearch strategy was used to search relevant literature updated on October 3, 2014 in PubMed, EMBASE andWEB of Science. Correlations between HDGF expression and clinicopathological features or cancer prognosiswas analyzed. All pooled HRs or ORs were derived from random-effects models. Twenty-six studies, primarilyin Eastern Asia, covering 2,803 patients were included in the analysis, all of them published during the pastdecade. We found that HDGF overexpression was significantly associated with overall survival (OS) (HROS=2.35,95%CI=2.04-2.71, p<0.001) and disease free survival (DFS) (HRDFS=2.25, 95%CI =1.81-2.79, p<0.001) in solidtumors, especially in non-small cell lung cancer, hepatocellular carcinoma and cholangiocarcinoma (CCA).Moreover, multivariate survival analysis showed that HDGF overexpression was an independent predictor ofpoor prognosis (HROS=2.41, 95%CI: 2.02-2.81, p<0.001; HRDFS=2.39, 95%CI: 1.77-3.24, p<0.001). In addition,HDGF overexpression was significantly associated with tumor category (T3-4 versus T1-2, OR=2.12, 95%CI:1.17-3.83, p=0.013) and lymph node status (N+ versus N-, OR=2.37, 95%CI: 1.31-4.29, p=0.03) in CCA. This studyprovides a comprehensive examination of the literature available on the association of HDGF overexpressionwith OS, DFS and some clinicopathological features in solid tumors. Meta-analysis results provide evidence thatHDGF may be a new indicator of poor cancer prognosis. Considering the limitations of the eligible studies, otherlarge-scale prospective trials must be conducted to clarify the prognostic value of HDGF in predicting cancersurvival.     

Depression in Women with Breast Cancer: A Systematic Review of Cross-Sectional Studies in Iran

Objective: Breast cancer is one of the most common cancers in women and has more severe mental and emotional effects than other types. Depression as a mental disorder affects people’s mental well-being, physical symptoms, occupational performance, and finally quality of life. The aim of this study was to determine depression levels in Iranian women with breast cancer. Methods: A systematic review study was conducted in 2017. English and Persian databases (PubMed, SCOPUS, Web of Science, Google Scholar, SID, Magiran) were searched with key words such as Depression Or Depressive Disorders AND Women AND Breast Cancer OR Tumor OR Neoplasm OR Malignancy AND Iran. Inclusion criteria allowed for cross-sectional studies conducted in Iran (published in English or Persian language journals), studies that had key words in their keywords or their titles and standard instruments for measuring depression in patients. Of the 160 publications found, eight were selected after reviewing the title, abstract and full article. Results: Age of women with breast cancer in selected studies ranged from 43.8 (SD = 47.1) to 55.9 (SD = 14.6) years. Duration of cancer in most studies was about 1-2 years. In most studies, mild levels of depression for women with breast cancer were present. However, in one study it was stated that 69.4% of participants had serious levels of depression. Conclusions: There is increase in the risk of depression in women with breast cancer. Therefore, it seems necessary to plan preventive and therapeutic measures in order to improve the mental health and quality of life of the affected patients.     

E-cadherin Immunohistochemical Expression as a Prognostic Factor in Infiltrating Ductal Carcinoma of the Breast: a Systematic Review and Meta-Analysis

PURPOSE: Multiple studies examining the relationship between loss of E-cadherin expression, a pivotal event for evolving metastatic behavior among epithelially derived cancers, and 5-year survival in infiltrating ductal breast carcinoma have yielded inconclusive and contradictory results. EXPERIMENTAL DESIGN: We conducted a systematic review of the PubMed database through August 2005 with no language restrictions to identify cohort studies that evaluated E-cadherin immunohistochemical expression as a prognostic marker for ductal breast carcinoma. 5-year all-cause mortality or 5-year breast cancer-specific mortality were the primary study outcomes. Meta-analysis was conducted using the REVMAN software and summary hazard ratios assuming both fixed effect and random effect models were calculated. RESULTS: Ten retrospective cohort studies were identified. Reduced or absent E-cadherin expression significantly increased the risk of all-cause mortality [combined HR = 1.55; 95% CI = 1.08-2.23] whereas a non-significant association was observed for breast cancer-specific mortality [combined HR = 0.70; 95% CI = 0.39-1.27]. We documented substantial inter-study heterogeneity with respect to all aspects of clinical data collection, immunohistochemical staining and interpretation as well as statistical modeling. These factors could not be formally analyzed but they challenge the robustness of our calculated summary estimates. CONCLUSIONS: Loss of E-cadherin expression may be an independent negative prognostic indicator for infiltrating ductal breast carcinoma and randomized, controlled studies evaluating this finding are justified. We encourage standardization of immunohistochemical techniques, data interpretation algorithms across laboratories and use of all-cause mortality to increase data compatibility and facilitate future efforts summarizing the utility of alternate prognostic markers in cancer.     

NSCLC Immunotherapy Efficacy and Antibiotic Use: A Systematic Review and Meta-Analysis

Immune checkpoint inhibitors (ICIs) have dramatically improved patient outcomes in a variety of tumor types, but with variable efficacy. Recent research has suggested that antibiotic-induced disruption of the microbiota may impact ICI efficacy. We performed a systematic review and meta-analysis of studies that assessed the impact of antibiotic use on the survival of patients diagnosed with NSCLC and treated with ICI. We systematically searched Medline, the Cochrane Library, and major oncology conferences proceedings. Eligible studies mentioned hazard ratio or Kaplan–Meier curves for progression-free survival (PFS) or overall survival (OS) based on antibiotic exposure before or during ICI treatment. We identified 23 eligible studies. The impact of antibiotics was then evaluated in 2208 patients for PFS and 5560 for OS. For both PFS and OS meta-analyses, the between-study heterogeneity was high (Higgins and Thompson I² of 69% and 80%, respectively). The pooled hazard ratio was 1.47 (95% confidence interval [CI]: 1.13–1.90) for PFS and 1.69 (95% CI: 1.25–2.29) for OS revealing a significantly reduced survival in patients with NSCLC exposed to antibiotics. The median OS was reduced on average by 6.7 months (95% CI: 5.1–8.4) in the patients exposed to antibiotics. The effect seems to depend on the time window of exposure with stronger effects reported when the patients took antibiotics [−60 days; +60 days] around ICI initiation. In patients with NSCLC, the findings of the meta-analysis indicate that antibiotic use before or during treatment with ICI leads to a median OS decreased by more than 6 months. Specifically, exposure shortly before or after ICI initiation seems to be particularly detrimental, whereas antibiotic use later during disease course does not seem to alter survival. Because PFS and OS were difficult to compare between studies owing to heterogeneity and the multiple confounding factors identified, further studies are needed to strengthen the understanding of this phenomenon.     

Effect of Vitamin D Deficiency on Liver Cancer Risk: A Systematic Review and Meta-Analysis

Epidemiological studies have showed that vitamin D deficiency can increase the risk of liver cancers. Hence, we conducted a meta-analysis to explore the relationship between 25-hydroxyvitamin D [25(OH)D] levels and liver cancer risk. Methods: Cochrane Library, Medline, Web of Science, and Embase were searched up to Mar. 2020, and the references of those studies were also searched by hand. A meta-analysis of 11 studies was performed which met the inclusion criteria. Six case–control studies and five cohort studies were included. Results: A total of 11 studies (6 case–control and 5 cohort studies) with 12,895 incident cases were included in the meta-analysis. The meta-analysis showed that liver cancer risk was significantly increased for vitamin D deficiency, and the pooled RR and its 95% CIs was 2.16 (1.2, 3.88; P = 0.01). In comparative analyses between 25(OH)D levels in patients with hepatocellular carcinoma(HCC) and those in the control group individuals, the summary RR of liver cancer was -1.11 (95% CI=-1.96 to -0.25). The subgroup analysis of the different geographical region of the population showed that the risk of liver cancer in Asian subgroup, European subgroup and Egyptian subgroup increased for vitamin D deficiency (RR=1.34,95% CI 0.72 to 2.48, p <0.00001; RR=2.53,95% CI 1.62 to 3.93,p <0.0001;RR=29.5,95% CI 4.14 to 209.93, P=0.88). Conclusion: The results of this meta-analysis indicate that vitamin D deficiency is associated with increased risk of liver cancer. The 25(OH)D3 levels are lower in HCC patients than those in health controls. Maintenance of sufficient serum vitamin D levels would be beneficial for prevention of liver cancer.     

Gastric Cancer in Ardabil,Iran - a Review and Update onCancer Registry Data

The incidence rate of gastric cancer in western countries has shown a remarkable decline in recent yearswhile it is still the most common cancer among men in Iran. Ardabil, a North Western province, was found tohave the highest rate of GC in Iran and one of the highest gastric cardia cancer rates in the world. We used themost recent data from Ardabil cancer registry to update on the incidence and mortality of GC and performedan extensive search of the English and Persian literature in Pub Med, Embase and all 5 Persian web-baseddatabases, respectively, to summarize all possible risk factors for GC in Ardabil. The age-standardized incidencerate of gastric cancer was 51.8 (95% CI: 47.8-55.8) in men and 24.9 (95% CI: 21.5-27.2) in women per 100,000.Age-standardized mortality rates for gastric cancer in this population were 32.2 (95% CI: 29.1-35.3) and 16.3(95% CI: 13.9-18.6). The gastric cardia sub-site was the most common location (32.7%) in Ardabil. Accordingto our review H.pylori infection, gastroesphageal reflux symptoms, tobacco smoking, and high intakes of salt,red meat and dairy products increase the risk of GC while diets with a high content of allium vegetables andfruits, especially citrus fruits, and consumption of fresh fish, were significantly protective against GC. Weconclude that Ardabil has the highest rate of GC in Iran and one the highest rates of gastric cardia cancer inthe world, with no evidence of decline in incidence since 2000. In addition to H.pylori infection, the epidemicof gastroesphageal reflux disease and several dietary factors may be responsible for the very high incidence ofgastric cardia cancer in Ardabil.     

Smoking Cessation Interventions for Chinese American Smokers: A Systematic Review and Meta-Analysis

Background: Smoking cessation interventions are important for decreasing lung cancer mortality rate among Chinese Americans. This study aims to investigate and summarize the intervention methods focusing on smoking cessation among Chinese Americans and to compare the effects of intervention methods on the smoking cessation rates. Methods: A systematic review and meta-analysis design was used in this study. Keyword searching was conducted in August 2021 on PubMed, Google Scholar, PsycINFO, and CINAHL. The methodological quality of each study was assessed using the PEDro scale or The Methodological item for non-randomized studies (MINORS). The Review Manager Version 5.4 software was used to conduct the meta-analysis. Random effect model and subgroup analysis were applied in the analysis. Results: Twenty and 11 studies were included in the systematic review and meta-analysis, respectively. Of the 20 studies, 8 were randomized control studies, 9 were pre-post single group intervention studies, 1 was retrospective analysis for an intervention study, 1 was a baseline data analysis from a cluster randomized trial, 1 was a feasibility intervention study. Results showed that compared to the control group, the group that received interventions on smoking cessation had a significantly increased smoking cessation rate (OR, 3.76; 95% CI, 1.72-8.21; P=0.0009). Subgroup analysis showed individual-based (OR, 5.88) NRT outreach interventions (OR, 3.80) conducted in person (OR, 2.53) with smokers (OR, 6.64) seemed to be more effective to increase smoking cessation rates among Chinese Americans compared with group-based, telephone counseling, indirect remote interventions conducted among Chinese American smokers and their non-smoke family members. Conclusions: Individual-based NRT outreach interventions conducted in person with smokers is an effective way to increase smoking cessation rates among Chinese Americans. More culturally sensitive and effective interventions are needed to help Chinese American smokers to quit smoking.     

Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis

Background/Objective: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. Methods: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. Results: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. Conclusion: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.