scholarly journals Neutrophil counts and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies

2018 ◽  
Author(s):  
Meghan A. Cupp ◽  
Margarita Cariolou ◽  
Ioanna Tzoulaki ◽  
Evangelou Evangelos ◽  
Antonio J. Berlanga-Taylor
Keyword(s):  
Systematic Reviews ◽  
Strong Evidence ◽  
Observational Studies ◽  
Cancer Prognosis ◽  
Small Study ◽  
List Type ◽  
Cancer Outcomes ◽  
Umbrella Review ◽  
Eligibility Criteria ◽  
Meta Analyses

ABSTRACTOBJECTIVETo evaluate the strength and validity of evidence on the association between the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis.DESIGNUmbrella review of systematic reviews and meta-analyses of observational studies.DATA SOURCESMedline, EMBASE, and Cochrane Database of Systematic Reviews.ELIGIBILITY CRITERIASystematic reviews or meta-analyses of observational studies evaluating the association between NLR or TAN and specific cancer outcomes related to disease progression or survival.DATA SYNTHESISThe available evidence was graded as strong, highly suggestive, suggestive, or weak through the application of pre-set grading criteria. For each included meta-analysis, the grading criteria considered the significance of the random effects estimate, the significance of the largest included study, the number of studies and individuals included, the heterogeneity between included studies, the 95% prediction intervals, presence of small study effects, excess significance and credibility ceilings.RESULTS239 meta-analyses investigating the association between NLR or TAN and cancer outcomes were identified from 57 published studies meeting the eligibility criteria, with 81 meta-analyses from 36 studies meeting the criteria for inclusion. No meta-analyses found a hazard ratio (HR) in the opposite direction of effect (HR<1). When assessed for significance and bias related to heterogeneity and small study effects, only three (4%) associations between NLR and outcomes in gastrointestinal and nasopharyngeal cancers were supported by strong evidence.CONCLUSIONDespite many publications exploring the association between NLR and cancer prognosis, the evidence is limited by significant heterogeneity and small study effects. There is a lack of evidence on the association between TAN and cancer prognosis, with all nine associations identified arising from the same study. Further research is required to provide strong evidence for associations between both TAN and NLR and poor cancer prognosis.REGISTRATIONThis umbrella review is registered on PROSPERO (CRD42017069131)FUNDINGMedical Research CouncilCOPYRIGHTOpen access article under terms of CC BYSHORT TITLENeutrophils and cancer prognosis: an umbrella reviewKEY RESULTWhen assessed for significance and bias related to heterogeneity and small study effects, only three (4%) associations between NLR and overall survival and progression-free survival in gastrointestinal and nasopharyngeal cancers were supported by strong evidence.WHAT THIS PAPER ADDSWHAT IS ALREADY KNOWN ON THE TOPICNeutrophil counts have been linked to the progression of cancer due to their tumourigenic role in the cancer microenvironment.Numerous meta-analyses and individual studies have explored the association between neutrophil counts and cancer outcomes for a variety of cancer sites, leading to a large body of evidence with variable strength and validity.Uncertainty exists around the association between neutrophils and cancer outcomes, depending on the site, outcome and treatments considered.WHAT THIS STUDY ADDSAll meta-analyses included in this review indicated an association between high neutrophil counts and poor cancer prognosis.There is strong evidence supporting the association between the neutrophil to lymphocyte ratio and poor cancer prognosis in some respiratory and gastrointestinal cancers.Further research is required to strengthen the existing body of evidence, particularly for the association between tumour-associated neutrophils and cancer outcomes.

scholarly journals Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Meghan A. Cupp ◽  
Margarita Cariolou ◽  
Ioanna Tzoulaki ◽  
Dagfinn Aune ◽  
Evangelos Evangelou ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Observational Studies ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cancer Prognosis ◽  
Cancer Outcomes ◽  
Lymphocyte Ratio ◽  
Cochrane Database ◽  
Increased Risk ◽  
Meta Analyses ◽  
Robust Evidence

Abstract Background Although neutrophils have been linked to the progression of cancer, uncertainty exists around their association with cancer outcomes, depending on the site, outcome and treatments considered. We aimed to evaluate the strength and validity of evidence on the association between either the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis. Methods We searched MEDLINE, Embase and Cochrane Database of Systematic Reviews from inception to 29 May 2020 for systematic reviews and meta-analyses of observational studies on neutrophil counts (here NLR or TAN) and specific cancer outcomes related to disease progression or survival. The available evidence was graded as strong, highly suggestive, suggestive, weak or uncertain through the application of pre-set GRADE criteria. Results A total of 204 meta-analyses from 86 studies investigating the association between either NLR or TAN and cancer outcomes met the criteria for inclusion. All but one meta-analyses found a hazard ratio (HR) which increased risk (HR > 1). We did not find sufficient meta-analyses to evaluate TAN and cancer outcomes (N = 9). When assessed for magnitude of effect, significance and bias related to heterogeneity and small study effects, 18 (9%) associations between NLR and outcomes in composite cancer endpoints (combined analysis), cancers treated with immunotherapy and some site specific cancers (urinary, nasopharyngeal, gastric, breast, endometrial, soft tissue sarcoma and hepatocellular cancers) were supported by strong evidence. Conclusion In total, 60 (29%) meta-analyses presented strong or highly suggestive evidence. Although the NLR and TAN hold clinical promise in their association with poor cancer prognosis, further research is required to provide robust evidence, assess causality and test clinical utility. Trial registration PROSPERO CRD42017069131.

scholarly journals Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses

10.2196/16791 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e16791 ◽  
Author(s):  
Patrick Timpel ◽  
Sarah Oswald ◽  
Peter E H Schwarz ◽  
Lorenz Harst
Keyword(s):  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Population Characteristics ◽  
Cochrane Library ◽  
Low Grade ◽  
Umbrella Review ◽  
Eligibility Criteria ◽  
Patients With Diabetes ◽  
Meta Analyses

Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.

scholarly journals Dietary Carbohydrate and Diverse Health Outcomes: Umbrella Review of 30 Systematic Reviews and Meta-Analyses of 281 Observational Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
Ya-Shu Liu ◽  
Qi-Jun Wu ◽  
Jia-Le Lv ◽  
Yu-Ting Jiang ◽  
Hui Sun ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Carbohydrate Intake ◽  
Dietary Carbohydrate ◽  
Umbrella Review ◽  
Suggestive Evidence ◽  
All Cause Mortality ◽  
Meta Analyses

Background and Aims: The associations between dietary carbohydrate and diverse health outcomes remain controversial and confusing. To summarize the existing evidence of the association between dietary carbohydrate intake and diverse health outcomes and to evaluate the credibility of these sources of evidence. We performed this umbrella review of evidence from meta-analyses of observational studies.Methods: PubMed, Embase, Web of Science databases, and manual screening of references up to July 2020 were searched. Systematic reviews with meta-analyses of observational studies in humans investigating the association between dietary carbohydrate intake and multiple health outcomes were identified. We assessed the evidence levels by using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis.Results: We included 43 meta-analyses of observational research studies with 23 health outcomes, including cancer (n = 26), mortality (n = 4), metabolic diseases (n = 4), digestive system outcomes (n = 3), and other outcomes [coronary heart disease (n = 2), stroke (n = 1), Parkinson's disease (n = 1), and bone fracture (n = 2)]. This umbrella review summarized 281 individual studies with 13,164,365 participants. Highly suggestive evidence of an association between dietary carbohydrate intake and metabolic syndrome was observed with adjusted summary odds ratio of 1.25 [95% confidence interval (CI) 1.15–1.37]. The suggestive evidences were observed in associations of carbohydrate consumption with esophageal adenocarcinoma (0.57, 95% CI = 0.42–0.78) and all-cause mortality (adjusted summary hazard ratio 1.19, 95% CI = 1.09–1.30).Conclusions: Despite the fact that numerous systematic reviews and meta-analyses have explored the relationship between carbohydrate intake and diverse health outcomes, there is no convincing evidence of a clear role of carbohydrate intake. However, there is highly suggestive evidence suggested carbohydrate intake is associated with high risk of metabolic syndrome, suggestive evidence found its association with increased risk of all-cause mortality and decreased risk of esophageal adenocarcinoma.Systematic Review Registration: CRD42020197424.

scholarly journals Risk factors for interpersonal violence: an umbrella review of meta-analyses

2018 ◽  
Vol 213 (4) ◽  
pp. 609-614 ◽  
Author(s):  
Seena Fazel ◽  
E. Naomi Smith ◽  
Zheng Chang ◽  
John Richard Geddes
Keyword(s):  
Risk Factors ◽  
Systematic Reviews ◽  
Interpersonal Violence ◽  
Research Evidence ◽  
Small Study ◽  
Modifiable Risk Factors ◽  
Umbrella Review ◽  
Population Effect ◽  
Health And Social Care ◽  
Meta Analyses

BackgroundInterpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.AimsWe aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence.MethodWe conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised.ResultsWe identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0–21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5–17.4%). There was evidence of small study effects and large heterogeneity.ConclusionsNational strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.Declarations of interestJ.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

scholarly journals Telomere length and health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies

2019 ◽  
Vol 51 ◽  
pp. 1-10 ◽  
Author(s):  
Lee Smith ◽  
Claudio Luchini ◽  
Jacopo Demurtas ◽  
Pinar Soysal ◽  
Brendon Stubbs ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Telomere Length ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Umbrella Review ◽  
Meta Analyses

The statins effects on HbA1c control among diabetic patients: An umbrella review of systematic reviews and meta-analyses of observational studies and clinical trials

2019 ◽  
Vol 13 (4) ◽  
pp. 2557-2564 ◽  
Author(s):  
Mohamed Anwar Hammad ◽  
Mahmoud Saeed Abdo ◽  
Abdalla Mohamed Mashaly ◽  
Syed Azhar Syed Sulaiman ◽  
Saleh Alghamdi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Diabetic Patients ◽  
Umbrella Review ◽  
Hba1c Control ◽  
Meta Analyses
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