Sentinel Lymph Node Molecular Ultrastaging in Patients With Melanoma: A Systematic Review and Meta-Analysis of Prognosis

2007 ◽  
Vol 25 (12) ◽  
pp. 1588-1595 ◽  
Author(s):  
Simone Mocellin ◽  
Dave S.B. Hoon ◽  
Pierluigi Pilati ◽  
Carlo R. Rossi ◽  
Donato Nitti
Keyword(s):  
Meta Analysis ◽  
Clinical Stage ◽  
Prognostic Indicator ◽  
Hematologic Malignancies ◽  
Disease Recurrence ◽  
Tnm Stage ◽  
Stage I ◽  
Clinical Implementation ◽  
Recurrence Rates ◽  
Statistical Heterogeneity

Purpose Molecular biology-based ultrastaging of cancer is already part of the standard management of patients with hematologic malignancies, whereas the evidence for solid tumors is much more debated. Polymerase chain reaction (PCR) –based detection of melanoma cells in sentinel lymph nodes (SLN) of patients with melanoma represents an appealing prognostic tool. However, no consensus exists on the clinical implementation of this prognostic indicator for the management of these patients. Methods Twenty-two studies enrolling 4,019 patients who underwent SLN biopsy for clinical stage I to II cutaneous melanoma were reviewed. Correlation of PCR status with TNM stage, disease recurrence rates, and survival was assessed by means of association statistics and formal meta-analysis, respectively. Results PCR status correlated with both TNM stage (stage I to II v III; PCR positivity, 95.1% v 46.6%; P < .0001) and disease recurrence (PCR positive v negative; relapse rate, 16.8% v 8.7%; P < .0001). PCR positivity was also associated with worse overall (hazard ratio [HR], 5.08; 95% CI, 1.83 to 14.08; P = .002) and disease-free (HR, 3.41; 95% CI, 1.86 to 6.24; P < .0001) survival. Statistical heterogeneity was significant, underscoring the variability among overall effect estimates across studies; metaregression and subgroup analysis did not identify clear-cut sources of heterogeneity, although some study design variables were suggested as potential causes. Conclusion PCR status of SLN appears to have a clinically valuable prognostic power in patients with melanoma. Although the heterogeneity of the studies so far published warrants caution to avoid overestimating the favorable results of pooled data, our findings strongly support additional investigation in this field.

Anatomic segmentectomy versus lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7071-7071
Author(s):  
Matthew J. Schuchert ◽  
Daniel Paul Normolle ◽  
Kristen N. McCormick ◽  
David O Wilson ◽  
Jill Siegfried ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Cox Regression ◽  
Clinical Stage ◽  
Survival Function ◽  
Primary Objective ◽  
Stage I ◽  
Recurrence Rates ◽  
Similar Time ◽  
Time To Recurrence

7071 Background: Although anatomic segmentectomy is considered a “compromised” procedure by many surgeons, new information from several retrospective, single-institution series has countered negative premises regarding tumor recurrence and patient survival. The primary objective of this study was to utilize propensity score matching to compare outcomes following these anatomic resection approaches for stage I NSCLC. Methods: Patients undergoing lobectomy (n=392) vs. segmentectomy (n=793) for clinical stage I NSCLC were matched 1:1 using a propensity score that accounted for the potential confounding effects of pre-operative patient variables. Matching based on propensity scores produced 312 patients in each group. Primary outcome variables included recurrence-free and overall survival. Factors affecting survival were assessed by proportional hazards (Cox) regression and Kaplan-Meier survival function estimates. Results: Peri-operative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (p=0.38). Ninety-day mortality was 2.6% and 4.8% (p=0.20), respectively. At a mean follow-up of 5.4 years, no differences were noted in locoregional (5.5% vs. 5.1%, p=1.00), distant (14.8% vs. 11.6%, p=0.29) or overall recurrence rates (20.2% vs. 16.7%, p=0.30) when comparing segmentectomy with lobectomy. Furthermore, no significant differences were noted in time to recurrence (p=0.415) or overall survival (p=0.258) when comparing the matched groups. Five year freedom from recurrence (95% CI) was: Segment 0.70 [95% CI: (0.63, 0.78) vs. Lobe 0.71 [95% CI: 0.64, 0.78]. Overall survival (95% CI) was: Segment 0.54 [95% CI: (0.47, 0.51) vs. Lobe 0.60 [95% CI: 0.54, 0.67]. Segmentectomy was not found to be an independent predictor of recurrence (HR: 1.11, 95% CI: 0.87, 1.40) or overall survival (HR = 1.17, 95% CI: 0.89.1.52). Conclusions: In this large propensity-matched comparison, anatomic segmentectomy is associated with similar time to recurrence and overall survival rates when compared to lobectomy for clinical stage I NSCLC. These results will need further validation by prospective, randomized trials (CALGB 140503).

scholarly journals Survival outcomes of lobectomy in comparison with segmentectomy in clinical stage I non-small-cell lung cancer: a meta-analysis

2019 ◽  
Author(s):  
Jian Feng ◽  
Yan-Yue Han ◽  
Yue Wang ◽  
Xiu-Yu Wu ◽  
Feng Lv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Literature Search ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Small Cell ◽  
Stage I ◽  
Survival Outcomes ◽  
Small Cell Lung

Abstract Background: The gold standard surgical therapy for patients with Clinical stage I non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection. While, segmentectomy has emerged as an alternative choice with the advantage of fewer postoperative complications. While the acceptance of this procedure still remains controversial, and conflicting results exist in the retrospective trials. Objectives: The aim of this meta-analysis was to analysis the survival outcomes of Lobectomy in comparison with segmentectomy in treatment of Clinical stage I non-small-cell lung cancer. Methods: Computerized literature search was done on the published trials in Pubmed, Embase, Cochrane library databases to June, 2019 to identify clinical trials. Lung cancer-specific survival (LCSS) and overall survival (OS) were measured as outcomes. Statistical analysis was performed in the Meta-analysis Revman 5.3 software. Results: A systematic literature search was conducted including 7 studies. In this meta-analysis, results indicate that lobectomy confers an equivalent survival outcome compared with segmentectomy. Conclusion: No significant differences were found in survival outcomes between lobectomy and segmentectomy. Further prospective large-scale, prospective, randomized trials are needed to explore the reasonable surgical treatment for early resectable lung cancer.

scholarly journals Survival Benefit of Metformin Adjuvant Treatment For Pancreatic Cancer Patients: a Systematic Review and Meta-Analysis

2018 ◽  
Vol 49 (3) ◽  
pp. 837-847 ◽  
Author(s):  
Guoxing Wan ◽  
Xue Sun ◽  
Fang Li ◽  
Xuanbin Wang ◽  
Chen Li ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Stage I ◽  
Metformin Therapy ◽  
Risk Of Death ◽  
Comprehensive Therapy

Background/Aims: Previous studies on the effect of metformin therapy on survival of pancreatic cancer patients obtained inconsistent findings. To reevaluate the prognostic value of metformin adjuvant treatment, a meta-analysis was carried out. Methods: Relevant articles addressing the association between metformin use and pancreatic cancer survival were electronically searched to identify eligible studies. Pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to assess the strength of the association. Results: Totally, seventeen studies involving 36791 participants were included. Overall, metformin use was found to be significantly associated with a favorable OS (HR=0.88, 95% CI=0.80-0.97). Subgroup analyses by ethnicity showed a significantly reduced risk of death for metformin users compared with non-users in Asians (HR=0.74, 95% CI=0.58-0.94) but nonsignificant in Caucasians. When stratified by clinical stage, a remarkable reduction of mortality risk in patients at stage I-II treated with metformin (HR=0.76, 95% CI=0.68-0.86) was found as well as the group at stage I-IV (HR=0.88, 95% CI=0.79-0.99), but not in patients at stage III-IV. In the stratification analyses based on treatment strategy, metformin therapy was found to be associated with a better clinical outcome in patients receiving surgery or comprehensive therapy (HR=0.73, 95% CI=0.62-0.87; HR=0.88, 95% CI=0.79-0.97) but not chemotherapy. However, the overall analysis failed to show a significant association between metformin use and DFS (HR=1.54, 95% CI=0.94 -2.50) with only 2 studies enrolled. Conclusion: The current study has evidenced a significant association of metformin adjuvant treatment with the survival benefit for pancreatic cancer patients, suggesting a potentially available option for the treatment. Further investigation is needed.

scholarly journals Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Ishita P. Miah ◽  
◽  
Yeliz Tank ◽  
Frits R. Rosendaal ◽  
Wilco C. Peul ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Subdural Hematoma ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Recurrence Risk ◽  
Individual Risk ◽  
Recurrence Rates ◽  
Statistical Heterogeneity

Abstract Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

scholarly journals Local Adjuvant Treatment with Low-Dose CpG-B Offers Durable Protection against Disease Recurrence in Clinical Stage I–II Melanoma: Data from Two Randomized Phase II Trials

2017 ◽  
Vol 23 (19) ◽  
pp. 5679-5686 ◽  
Author(s):  
Bas D. Koster ◽  
Mari F.C.M. van den Hout ◽  
Berbel J.R. Sluijter ◽  
Barbara G. Molenkamp ◽  
Ronald J.C.L.M. Vuylsteke ◽  
...  
Keyword(s):  
Phase Ii ◽  
Adjuvant Treatment ◽  
Low Dose ◽  
Clinical Stage ◽  
Disease Recurrence ◽  
Stage I ◽  
Phase Ii Trials ◽  
Randomized Phase Ii

scholarly journals Quality of Surveillance for Stage I Testis Cancer in the Community

2009 ◽  
Vol 27 (26) ◽  
pp. 4327-4332 ◽  
Author(s):  
Hua-yin Yu ◽  
Rodger A. Madison ◽  
Claude M. Setodji ◽  
Christopher S. Saigal
Keyword(s):  
Private Insurance ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Retroperitoneal Lymph Node Dissection ◽  
Testis Cancer ◽  
First Year ◽  
Recurrence Rates

Purpose Patients with clinical stage I testicular germ cell tumors have been managed with adjuvant radiotherapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). The use of surveillance-only strategies at referral centers has yielded survival outcomes comparable to those achieved with adjuvant therapy. We evaluated compliance with follow-up protocols developed at referral centers within the community. Methods We identified patients with stage I testis cancer within a large private insurance claims database and calculated compliance of follow-up test use with guidelines from the National Comprehensive Cancer Network. Results Surveillance was widely used in the community. Compliance with surveillance and postadjuvant therapy follow-up testing was poor and degraded with increasing time from diagnosis. Nearly 30% of all surveillance patients received no abdominal imaging, chest imaging, or tumor marker tests within the first year of diagnosis. Patients who elected RPLND were most compliant with recommended follow-up testing within the first year. Recurrence rates were consistent with previously reported literature, despite poor compliance. Conclusion Surveillance is a widely accepted strategy in clinical stage I testicular cancer treatment in the community. However, follow-up care recommendations developed at referral centers are not being adhered to in the community. Although recurrence rates are similar to those of reported literature, the clinical impact of noncompliance on recurrence severity and mortality are not known. Further prospective work needs to be done to evaluate this apparent quality of care problem in the community.

scholarly journals Survival Outcomes of Lobectomy in Comparison With Segmentectomy in Clinical Stage I Non-small-cell Lung Cancer: a Meta-analysis

2021 ◽  
Author(s):  
Jian Feng ◽  
Yan-Yue Han ◽  
Yue Wang ◽  
Xiu-Yu Wu ◽  
Feng Lv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Literature Search ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Small Cell ◽  
Stage I ◽  
Survival Outcomes ◽  
Small Cell Lung

Abstract Background: The gold standard surgical therapy for patients with clinical stage I non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection. While, segmentectomy has emerged as an alternative choice with the advantage of fewer postoperative complications. However, the acceptance of this procedure still remains controversial, and conflicting results exist in the retrospective trials.Objectives: The aim of this meta-analysis was to analysis the survival outcomes of lobectomy in comparison with segmentectomy in treatment of clinical stage I non-small-cell lung cancer. Methods: Computerized literature search was done on the published trials in Pubmed, Embase, Cochrane library databases to June, 2019 to identify clinical trials. Lung cancer-specific survival (LCSS) and overall survival (OS) were measured as outcomes. Statistical analysis was performed using the Meta-analysis Revman 5.3 software.Results: A systematic literature search was conducted including 7 studies. In this meta-analysis, results indicate that lobectomy confers an equivalent survival outcome compared with segmentectomy. Conclusion: No significant differences were found in survival outcomes between lobectomy and segmentectomy. Further prospective large-scale, prospective, randomized trials are needed to explore the reasonable surgical treatment for early resectable lung cancer.

scholarly journals Risk of Recurrence in Uterine Leiomyoma with Bizarre Nuclei: a Systematic Review and Meta-Analysis

2021 ◽  
Vol 81 (11) ◽  
pp. 1217-1223
Author(s):  
Antonio Travaglino ◽  
Antonio Raffone ◽  
Angela Santoro ◽  
Diego Raimondo ◽  
Francesco Paolo Improda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Uterine Leiomyoma ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Uncertain Malignant Potential ◽  
Recurrence Rates ◽  
Risk Of Recurrence ◽  
Smooth Muscle Tumors ◽  
Statistical Heterogeneity ◽  
Previous Category

Abstract Objective Leiomyoma with bizarre nuclei (LBN) is a variant of uterine leiomyoma, which has replaced the previous category of “atypical leiomyoma” and must be distinguished from smooth muscle tumors of uncertain malignant potential (STUMP). However, previously published series of “atypical leiomyoma” might have included both LBN and STUMP, due to the lack of strict diagnostic criteria. Based on such hypothesis, we aimed to define the risk of recurrence in LBN. Study Design A systematic review and meta-analysis was performed by searching 4 electronic databases for all studies assessing the outcome of patients with “atypical leiomyoma” or LBN. The pooled absolute risk of recurrence was calculated. The included studies were subdivided into two subgroups based on the criteria used: “LBN + STUMP” or “LBN-only”. Results Twelve studies with 433 patients were included. The pooled risk of recurrence was 5.5% overall. The funnel plot showed two cluster of studies which superimposed to the two subgroups. In the LBN + STUMP cluster/subgroup, the pooled risk of recurrence was 7.7%. In the LBN-only cluster/subgroup, the pooled risk of recurrence was 1.9%. Statistical heterogeneity was null in all analyses. Conclusion Our results show a risk of recurrence of 1.9% for LBN; higher recurrence rates in older studies are likely due to the inclusion of STUMPs.

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