scholarly journals Radiotherapy with radical cystectomy for bladder cancer: A systematic review and meta-analysis

2018 ◽  
Vol 12 (10) ◽  
Author(s):  
Kristen McAlpine ◽  
Dean A. Fergusson ◽  
Rodney H. Breau ◽  
Luke F. Reynolds ◽  
Risa Shorr ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Intervention Group ◽  
Pooled Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Neoadjuvant Radiotherapy ◽  
Treatment Techniques

Introduction: Muscle-invasive bladder cancer (MIBC) is associated with high recurrence and mortality rates. The role of radiotherapy as an adjunct to radical cystectomy is not well-defined. We sought to evaluate the efficacy and safety of radiotherapy preoperatively or postoperatively for patients with MIBC receiving cystectomy compared to cystectomy alone. The primary outcome was overall survival. The secondary outcome was adverse effects.Methods: MEDLINE, EMBASE, and CENTRAL were searched on August 30, 2016 for randomized controlled trials (RCTs) of patients undergoing cystectomy for bladder cancer. A control group receiving cystectomy alone and an intervention group with radiotherapy and cystectomy were required. The Jadad score was used to assess for bias. Fifteen studies representing 10 RCTs met eligibility criteria.Results: A total of 996 patients were randomized in seven trials included in a meta-analysis of neoadjuvant radiotherapy. Insufficient data were available to complete a pooled analysis for adjuvant radiotherapy. There was a non-statistically significant improvement in overall survival for patients who received neoadjuvant radiotherapy and cystectomy. At three years and five years, the odds ratios were 1.23 (95% confidence interval [CI] 0.72–2.09) and 1.26 (95% CI 0.76–2.09), respectively, in favour of neoadjuvant radiotherapy. Subgroup analyses including higher doses of radiotherapy showed greater effect on survival.Conclusions: These data suggest that radiotherapy prior to cystectomy may improve overall survival. This review was limited by old studies, heterogeneous patient populations, and radiotherapy treatment techniques that may not meet current standards. There is a need for current RCTs to further evaluate this effect.

scholarly journals Meta-analysis of neoadjuvant chemotherapy compared to radical cystectomy alone in improving overall survival of muscle-invasive bladder cancer patients

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Agus Rizal A. H. Hamid ◽  
Fanny Riana Ridwan ◽  
Dyandra Parikesit ◽  
Fina Widia ◽  
Chaidir Arif Mochtar ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Total Sample ◽  
Invasive Bladder Cancer ◽  
Forest Plot ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Abstract Background Most patients with muscle-invasive bladder cancer (MIBC) developed metastasis within 2 years, even after radical cystectomy (RC). The recurrence rate of MIBC was more than 50% of the cases. A meta-analysis conducted by Yin et al. showed that neoadjuvant chemotherapy (NAC) + RC improves overall survival in MIBC compared with RC only. However, a new meta-analysis by Li et al. concluded that NAC + RC was not superior to RC only in improving overall survival. The inconsistencies of these studies required further comprehensive analysis to recommend NAC use in bladder cancer treatment. Therefore, this meta-analysis aims to analyze previous studies that compare the efficacy of NAC + RC versus RC only to improve overall survival of MIBC. Methods The articles were searched using Pubmed with keywords “muscle-invasive bladder cancer”, “neoadjuvant chemotherapy”, “cystectomy”, and “overall survival”. The articles that were published until June 2020 were screened. The overall survival outcome was analyzed as hazard ratio (HR) and presented in a forest plot. Result Seventeen studies were included in meta-analysis with a total sample of 13,391 patients, consist of 2890 received NAC followed by RC and 10,418 underwent RC only. Two studies used methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), two studies used gemcitabine/cisplatin (GC), one study used Cisplatin-based regimen, one study used MVAC or GC, one study used gemcitabine/carboplatin (GCarbo) or GC or MVAC, one study used Cisplatin/Gemcitabine or MVAC, one study used Cisplatin only, one study used Cisplatin-based (GC, MVAC) or non-Cisplatin-based (combined paclitaxel/gemcitabine/carboplatin), one study used GC, MVAC, Carboplatin, or Gemcitabine/Nedaplatin (GN), and five studies did not mention the regimen The overall survival in the NAC + RC only group was significantly better than the RC only group (HR 0.82 [0.71–0.95], p = 0.009). Conclusion NAC + RC is recommended to improve overall survival in MIBC patients. A further study assessing side effects and quality of life regarding NAC + RC is needed to establish a strong recommendation regarding this therapy.

scholarly journals BCG vaccination impact on mortality and recovery rates in COVID-19: A meta-analysis

2021 ◽  
Author(s):  
Surjit Singh ◽  
Daisy Khera ◽  
Ankita Chugh ◽  
Sameer Khasbage ◽  
Pushpinder S. Khera ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Recovery Rate ◽  
Meta Analysis ◽  
Intervention Group ◽  
Group Versus ◽  
Pooled Analysis ◽  
Control Group ◽  
P Value ◽  
Vaccination Policy ◽  
Bcg Vaccination

COVID-19 is a pandemic caused by SARS-CoV-2 virus which is a very worrisome public health emergency. In this study, we compared the mortality rate and recovery rate in countries with and without BCG vaccination policy. The data of mortality of COVID-19 was extracted from worldometer (https://www.worldometers.info/coronavirus/) on 26th July 2020. The data of countries where BCG vaccination is being done for all individuals is taken from BCG world atlas (http://www.bcgatlas.org/index.php), updated in 2017. BCG vaccination policy recommended countries are intervention group versus countries without BCG vaccination policies which are regarded as control group. Pooled analysis of countries with and without BCG vaccination policy revealed mortality rate of 1.31% (95%CI – 1.31% to 1.32%; I2 = 100%, p<0.01) and 3.25% (95%CI – 3.23% to 3.26%; I2 = 100%, p<0.01), respectively. The recovery rate in two country groups were found to be 72.60% (95%CI – 72.57% to 72.63%) and 55.94% (95%CI – 55.90% to 55.98%), respectively. 52 individuals need to be BCG vaccinated to prevent one death (NNT = 52). In BCG vaccination program countries, there is statistically and clinically significant less mortality (p-value <0.001) as compared to countries without BCG policy. Our findings corroborate the hypothesis that BCG vaccination may provide protection from COVID-19. High quality evidence from randomised controlled trials are required to establish causality between BCG vaccination and protection from severe COVID-19.

scholarly journals Efficacy of Nucleot(s)ide Analogs Therapy in Patients with Unresectable HBV-Related Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Lingling He ◽  
Xiaoli Liu ◽  
Yalin Zhao ◽  
Shuan Zhang ◽  
Yuyong Jiang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Best Practice ◽  
Therapy Group ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Treated Group ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Control Group ◽  
Free Survival

Aim. To determine whether nucleot(s)ide analogs therapy has survival benefit for patients with HBV-related HCC after unresectable treatment.Method. A systematic search was conducted through seven electronic databases including PubMed, OVID, EMBASE, Cochrane Databases, Elsevier, Wiley Online Library, and BMJ Best Practice. All studies comparing NA combined with unresectable treatment versus unresectable treatment alone were considered for inclusion. The primary outcome was the overall survival (OS) after unresectable treatment for patients with HBV-related HCC. The secondary outcome was the progression-free survival (PFS). Results were expressed as hazard ratio (HR) for survival with 95% confidence intervals.Results. We included six studies with 994 patients: 409 patients in nucleot(s)ide analogs therapy group and 585 patients without antiviral therapy in control group. There were significant improvements for the overall survival (HR = 0.57; 95% CI = 0.47–0.70;p< 0.001) and progression-free survival (HR = 0.84; 95% CI = 0.71–0.99;p= 0.034) in the NA-treated group compared with the control group. Funnel plot showed that there was no significant publication bias in these studies. When it comes to antiviral drugs and operation method, it also showed benefit in NA-treated group. At the same time, overall mortality as well as mortality secondary to liver failure in NA-treated group was obviously lesser. Sensitivity analyses confirmed the robustness of the results.Conclusions. Nucleot(s)ide analogs therapy after unresectable treatment has potential beneficial effects in terms of overall survival and progression-free survival. NA therapy should be considered in clinical practice.

scholarly journals Effects of Panax ginseng on Obesity in Animal Models: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Hye-Sung Park ◽  
Jae-Heung Cho ◽  
Koh-Woon Kim ◽  
Won-Seok Chung ◽  
Mi-Yeon Song
Keyword(s):  
Body Weight ◽  
Animal Models ◽  
Panax Ginseng ◽  
Meta Analysis ◽  
Intervention Group ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Control Group ◽  
Final Body Weight ◽  
Lower Body Weight

Objective. To determine the antiobesity effects of Panax ginseng in animals. Methods. We conducted a systematic search for all controlled trials (up to March 2017) that assessed the antiobesity effects of P. ginseng in animal obesity models in the PubMed, EMBASE, Cochrane library, Web of Science, and Scopus databases. The primary outcome was final body weight measured at the longest follow-up time after administration of the intervention. The secondary outcome was the lipid profile. We assessed methodological quality using the SYRCLE risk of bias tool, and RevMan 5.3 was used to perform a meta-analysis. Finally, a subgroup analysis of parameters including intervention duration, animal models, and type of ginseng was performed. Result. We identified 16 studies that met the inclusion criteria. Data from the meta-analysis indicated that the intervention group had a significantly lower body weight than the control group (SMD: −1.50, 95% CI: −1.90 to −1.11, χ2: 78.14, P<0.0001, I2 = 58%). Final body weight was lower in an animal obesity model induced by high-fat diet than in genetic models. Also the intervention group had a significantly higher serum HDL level and lower serum LDL, TG, and TC level than the control group. Conclusion. Our meta-analysis indicated that oral administration of P. ginseng significantly inhibits weight gain and improves serum lipid profiles in animal obesity models. However, causes of obesity and type of ginseng may affect treatment effects.

scholarly journals Efficacy of Physical Therapy Interventions on Quality of Life and Upper Quadrant Pain Severity in Women With Post-Mastectomy Pain Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Priya Kannan ◽  
Lam Hiu Ying ◽  
Ma Tsz Kiu ◽  
Lo Chiu Ngai ◽  
Mui Ting Yan ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Meta Analysis ◽  
Intervention Group ◽  
Pain Syndrome ◽  
Compression Therapy ◽  
Pooled Analysis ◽  
Pain Severity ◽  
Control Group ◽  
Myofascial Release ◽  
Therapy Interventions

Abstract Purpose: To determine the efficacy of physical therapy interventions on quality of life (QoL) and pain severity in women with post-mastectomy pain syndrome (PMPS).Methods: Multiple databases were searched from database inception-October 2020. Randomized controlled trials comparing physical therapy interventions to control were included. Results: Eighteen trials were included in the review. The pooled analysis of the four exercise trials revealed a statistically significant effect of the intervention on general (p=0.001), physical (p=0.044) and mental health components (p=0.027) of QoL, when compared to the control condition. Pooled analysis of data from six exercise trials revealed a significant effect of exercise interventions compared to control on pain severity (p<0.001). Meta-analysis of data from two myofascial release trials showed a significantly greater reduction in pain severity in the intervention group compared to the control group (p=0.04). The pooled analysis of data from two acupuncture trials revealed a significant reduction in pain severity in the intervention group compared to the control group (p=0.003). Pooled analysis of data from two trials revealed a non-significant effect of compression therapy compared to control on pain severity (p>0.05) Conclusion: This review found that exercise is beneficial for improving QoL and alleviating upper quadrant pain severity in women with PMPS. Myofascial release and acupuncture were more effective than the control condition in reducing the pain severity in PMPS. The effect of compression therapy, complex decongestive therapy and neuromuscular taping on PMPS remains inconclusive, and future research is required to validate the effect of these interventions on PMPS.

scholarly journals Lithium carbonate as add-on therapy to radioiodine in the treatment on hyperthyroidism: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed Abd-ElGawad ◽  
Mohamed Abdelmonem ◽  
Ahmed Eissa Ahmed ◽  
Omar Magdy Mohammed ◽  
Mohamed Sayed Zaazouee ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Radioactive Iodine ◽  
Meta Analysis ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Randomized Control Trials ◽  
Cure Rate ◽  
Significant Difference ◽  
Randomized Control

Abstract Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals Sofosbuvir with daclatasvir and the outcomes of patients with COVID-19: a systematic review and meta-analysis with GRADE assessment

2021 ◽  
pp. postgradmedj-2021-140287
Author(s):  
Ahmad Fariz Malvi Zamzam Zein ◽  
Catur Setiya Sulistiyana ◽  
Wilson Matthew Raffaello ◽  
Arief Wibowo ◽  
Raymond Pranata
Keyword(s):  
Systematic Review ◽  
Absolute Risk ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Intervention Group ◽  
Control Group ◽  
Reduce Mortality Rate ◽  
Icu Admission ◽  
Clinical Recovery

PurposeThis systematic review and meta-analysis aimed to evaluate the effect of sofosbuvir/daclatasvir (SOF/DCV) on mortality, the need for intensive care unit (ICU) admission or invasive mechanical ventilation (IMV) and clinical recovery in patients with COVID-19.MethodsWe performed a systematic literature search through the PubMed, Scopus and Embase from the inception of databases until 6 April 2021. The intervention group was SOF/DCV, and the control group was standard of care. The primary outcome was mortality, defined as clinically validated death. The secondary outcomes were (1) the need for ICU admission or IMV and (2) clinical recovery. The pooled effect estimates were reported as risk ratios (RRs).ResultsThere were four studies with a total of 231 patients in this meta-analysis. Three studies were randomised controlled trial, and one study was non-randomised. SOF/DCV was associated with lower mortality (RR: 0.31 (0.12, 0.78); p=0.013; I2: 0%) and reduced need for ICU admission or IMV (RR: 0.35 (0.18, 0.69); p=0.002; I2: 0%). Clinical recovery was achieved more frequently in the SOF/DCV (RR: 1.20 (1.04, 1.37); p=0.011; I2: 21.1%). There was a moderate certainty of evidence for mortality and need for ICU/IMV outcome, and a low certainty of evidence for clinical recovery. The absolute risk reductions were 140 fewer per 1000 for mortality and 186 fewer per 1000 for the need for ICU/IMV. The increase in clinical recovery was 146 more per 1000.ConclusionSOF/DCV may reduce mortality rate and need for ICU/IMV in patients with COVID-19 while increasing the chance for clinical recovery.Protocol registrationPROSPERO: CRD42021247510.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies

2021 ◽  
pp. 1-7
Author(s):  
Renata da R. M. Rodrigues ◽  
Bruna K. Hassan ◽  
Michele R. Sgambato ◽  
Bárbara da S. N. Souza ◽  
Diana B. Cunha ◽  
...  
Keyword(s):  
Eating Habits ◽  
Intervention Group ◽  
Pooled Analysis ◽  
Control Group ◽  
Intention To Treat ◽  
School Year ◽  
School Based ◽  
Obesity Interventions ◽  
The One ◽  
And Control

Abstract School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

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