Top PDF Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis.

Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis.

Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis.

directly reported, they were estimated according to the available survival data by using the method reported by Palmar et al [8]. An observed HR .1 implied a worse survival for the study group with positive LVI, relative to the reference group. The impact of LVI on outcome was considered statistically significant if the 95% CI did not overlap with 1 and if p,0.05. We also performed subgroup analyses to examine if our pooled estimate of the prognostic value was influenced by publication year, region, number of patients, pathologic N stage, median follow-up, HR estimation, analysis results, and methodological quality scales. To evaluate the robustness of the combined HR and to check the stability of meta-analysis, sensitivity analyses were performed by removing one study at a time. A test of heterogeneity of the combined HRs was carried out using the Chi-square test and Higgins I-squared statistic. P,0.10 was considered to represent substantial heterogeneity between studies. I 2 .50% indicated large heterogeneity among studies, whereas I 2 values between 25% and 50% indicated moderate heterogeneity [9]. Publication bias was evaluated using the funnel plot. The Begg’s rank correlation and Egger’s linear regression were also applied to assess the potential publication bias. The nomnial level of significance was set at 5%. All 95% CIs were two-sided. The meta-analysis was performed using Review Manager (RevMan) software version 5.0 (RevMan 5; The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark). Publication biases were evaluated by R 2.13.0 (R Development Core Team, Vienna, Austria, http:// www.R-project.org).
Mostrar mais

9 Ler mais

Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis.

Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis.

The present meta-analysis has limitations. First, the most important limitation is that all of the included studies were retrospective samples rather than randomized controlled trials, and the clinicians could not be blinded to the selection of patients who received BT. Multivariable models were used in the included studies, but the adjusted cofounders were not the same for the adjusted HRs (Table 3). Therefore, we were unable to conduct stratified analyses based on possible confounders, such as preoperative hemoglobin levels or perioperative blood losses. Some studies demonstrated that estimated blood loss was an independent factor to predict sur- vival or recurrence after surgery [33, 34], but only 3 of the 6 studies in this meta-analysis con- sidered intraoperative blood loss [13, 15, 21]. Several reports suggested that intraoperative blood loss during surgery for cancer is a critical risk factor of mortality and recurrence. Nota- bly, Linder et al. repeated their multivariate analysis to include the variable of estimate blood loss in response to this issue, and they discovered that PBT remained significantly associated with increased risks of cancer-specific mortality (HR: 1.26; P = 0.017) and all-cause mortality (HR: 1.30; P = 0.0002) [21]. Second, studies performed with positive results or significant out- comes are more apt to be published, which suggests a potential publication bias. The sample sizes of enrolled research (from 350 to 2,895) varied widely; therefore, the statistical power or weight of each study was greatly different, which inevitably causes bias to varying degrees. In addition, one report did not provide sufficient data and was excluded from our analysis [19]. Third, reports in languages other than English were excluded, so a potential language bias may be present in our meta-analysis.
Mostrar mais

11 Ler mais

Blood vessel invasion as a strong independent prognostic indicator in non-small cell lung cancer: a systematic review and meta-analysis.

Blood vessel invasion as a strong independent prognostic indicator in non-small cell lung cancer: a systematic review and meta-analysis.

Our meta-analysis had some limitations. First, the level of evidence obtained by retrospective studies is lower than that provided by randomized controlled trials. Second, data from published trials rather than individual patient data were used in the systematic review. Third, in most of meta-analyses, there was evidence of significant heterogeneity although the random-effect model based on Mantel–Haenszel method rather than the fixed- effect model was applied. Studies may have differed with regard to the baseline characteristics of the patients included, the adjuvant treatment they might have received, the duration of follow-up, and adjustments for other cofactors. For example, some studies included a small number of stage IV or IIIB patients, which accounted for the heterogeneity. These studies were finally maintained in the meta-analyses because the overall designs of studies were similar to those used in the other studies. Many variations to the method of BVI assessment exist, although in most studies BVI was defined as the presence of neoplastic structures inside the lumen of a vessel. Some studies detected BVI by staining with hematoxylin and eosin alone or in combination with elastic- van Gieson stain or by staining with Victoria blue hematoxylin Table 2. Results of meta-analysis of blood vessel invasion and prognosis in NSCLC.
Mostrar mais

8 Ler mais

The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis.

The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis.

(31 cases) and wild-type BRAF/NRAS group (80 cases). There was no data available for the effect of BRAF mutation alone on patient survival in this report. In a very similar study, Houben et al [51] evaluated the effect of combined mutation of BRAF and NRAS mutation in 200 patients and reported a poor overall survival prognosis for metastatic samples which harbor either BRAF or NRAS mutation. However, they did not observe the same pattern in primary melanoma patients. As these two reports did not provide any information on the effect of BRAF mutation per se on patient survival we did not include them in our final meta-analysis. The inconsistency of results in these reports could be due to the fact that they combined BRAF and NRAS mutation and classified this group of patients together. In addition, Akslen et al [14] and Chang et al [15] reported no difference in patient survival in 69 and 68 cases respectively according to their BRAF mutation status. However, no details on patient survival have been provided in these reports. Akslen et al [14] mostly focused on different BRAF and NRAS mutations and their combinations and possible correlation with clinicopathologic characteristics. They reported that BRAF and NRAS mutations are mutually exclusive except for one case but they did not find any correlation with tumor cell proliferation, thickness or vascular invasion. Although they reported a median follow-up time of 76 months for the patients, no detailed information on mean survival time in each arm of the study was provided. There was no survival curve available in this report either. In a separate study, Chang et al [15] observed a significant trend for liver metastasis and tendency for multiple organ metastasis in BRAF mutant group but they did not detect a significant difference in either clinicopathological characteristics or in patient survival. Basically in this study authors chose a descriptive method to explain their observation and just mentioned that they did not find any correlation between patient survival and BRAF mutation. Unfortunately, no more detailed information including mean survival time in each group of study or a survival graph has been provided by the authors. A need for a conclusive meta-analysis on the effect of BRAF mutation on melanoma patient survival has been emerged due to the controversial reports on this issue. In our meta-analysis, we combined the results of four independent studies and measured the pooled risk of BRAF mutation on melanoma patient survival. So far our report is the first study on this issue which demonstrates the correlation between BRAF mutation and poor melanoma patient survival in a reliable statistical point of view. The number of reports on BRAF mutation and colorectal cancer were enough to pool the results together and perform a meta-analysis. Therefore, our findings in the pooled data suggest that with successful BRAF
Mostrar mais

10 Ler mais

Int. braz j urol.  vol.33 número2

Int. braz j urol. vol.33 número2

On the other hand, in patients with muscle- infiltrating bladder cancer while the value of the tumor stage, grade, presence of carcinoma in situ and lymph node (LN) involvement are being widely studied, our knowledge as to the frequency and significance of the PNI is minimum. The PNI is reported in 6.8 to 47.7% of the patients with transitional cell carcinoma (TCC) of the bladder treated with radical cystectomy (1,2,11-14). While in the majority of such studies the PNI is related to disease-free survival (12,14) and global survival (2,12) only in univariate analysis, others have demonstrated that the PNI also presents a prognostic value in multivariate analysis (13).
Mostrar mais

6 Ler mais

Prognostic Value of Cancer Stem Cell Marker ALDH1 Expression in Colorectal Cancer: A Systematic Review and Meta-Analysis.

Prognostic Value of Cancer Stem Cell Marker ALDH1 Expression in Colorectal Cancer: A Systematic Review and Meta-Analysis.

The ALDH1 gene is located on chromosome 12 (12q24.2) and expresses a type of detoxify- ing enzyme, which contributes to the oxidation of intracellular aldehydes [5]. ALDH1 confers resistance to alkylating chemotherapeutic agents and protects against oxidative damage by catalyzing the irreversible oxidization of cellular aldehydes [6]. ALDH1 is involved in the metabolism of retinaldehyde to retinoic acid, a signaling molecule that contributes to cellular differentiation and proliferation [7]. ALDH1-positive cells with CSC properties, such as differ- entiation, self-renewal and tumorigenicity, have a higher capacity in xenotransplantation and chemoradiotherapy resistance and correlate with a poor prognosis of breast cancer [8]. In addi- tion, ALDH1 activity has been shown to identify CSC-like cells in head and neck neoplasm [9]. ALDH1 appears to be a bio-marker that can be applied to isolate the CSC population in tumors obtained from patients with pancreatic cancer or CRC [7,10]. Furthermore, ALDH1 acts as a promoter, inducing epithelial-mesenchymal transition (EMT) in cancer cells [11]. EMT pro- motes epithelial cancer cells to obtain stemness and correlates with tumor invasion and metas- tasis [12]. In recent years, many studies have reported that ALDH1 expression correlates with a poor clinical prognosis in lung, prostate, pancreatic, and gastric cancers as well as in CRC [2,13]. However, among numerous independent studies, the prognostic value of ALDH1 for CRC remains controversial. Many studies have reported that ALDH1 is an independent prog- nostic marker associated with the clinicopathological features and poor OS in CRC [14,15]. Yet, some studies indicate that ALDH1 is not related to tumor stage or patient age [16]. Thus, this systematic review was conducted to evaluate the association between ALDH1 expression and OS, DFS as well as clinicopathological features of CRC.
Mostrar mais

15 Ler mais

Int. braz j urol.  vol.29 número2

Int. braz j urol. vol.29 número2

radiotherapy subsequently where subjected to salvage-cystectomy. The survival rate after 5 years was roughly 40%, the median survival rate was roughly 50% in both groups. In conclusion, this contribution is worth reading and shows the treatment results in a country where radiotherapy and not cystectomy is the primary choice of treatment in invasive bladder tumours. Certainly, from the continental point of you, radical cystectomy still can be considered the treatment of choice, but alternatives, such as radiotherapy, have to be kept in mind.
Mostrar mais

4 Ler mais

Int. braz j urol.  vol.34 número1

Int. braz j urol. vol.34 número1

Objectives: To report our experience with laparoscopic radical cystectomy and extracorporeal urinary diversion for high-grade muscle invasive bladder cancer in a consecutive series of 48 patients with 3 years of follow-up. Methods: From June 1999 to April 2006, 48 patients (42 men and 6 women; mean age 59 years, range 24 to 80) with bladder cancer underwent laparoscopic radical cystectomy and bilateral pelvic lymph node dissection at our institution. Urinary diversion was done extracorporeally through the specimen extraction incision.
Mostrar mais

3 Ler mais

Int. braz j urol.  vol.39 número3

Int. braz j urol. vol.39 número3

Results: Five patients had a pT0 stage after radical cystectomy. Four of them had transi- tional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. Conclusions: Four factors were identified in our study to contribute towards a pT0 cys- tectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result.
Mostrar mais

7 Ler mais

Prognostic value of tissue inhibitor of metalloproteinase-2 expression in patients with non-small cell lung cancer: a systematic review and meta-analysis.

Prognostic value of tissue inhibitor of metalloproteinase-2 expression in patients with non-small cell lung cancer: a systematic review and meta-analysis.

Subgroup analysis is a method for exploring the sources of heterogeneity and for increasing the reliability of an article. Tumor stage is an important factor that affects the prognosis of NSCLC [39]. While the patients in the included studies were of different disease stages, Zhu et al. studied only stage IB NSCLC patients [14], and Li et al. did not report the disease stage of the pa- tients they enrolled [28]. Therefore, we performed subgroup analysis according to stage, and found that TIMP-2 expression was a statistically significant favorable factor in patients with stage I-IV NSCLC. From this, we may assume that high TIMP-2 expression is not only related to out- come in early-stage NSCLC, but also the late stages. The methods used to measure TIMP-2 ex- pression varied between the studies, which may have reduced the reliability of our result. We selected the most commonly applied method, i.e., IHC, for the subgroup analysis and found that the conclusion that high TIMP-2 expression is associated with good prognosis in NSCLC re- mained the same if only IHC was used to assess TIMP-2 expression levels. The percentage of high TIMP-2 expression of patients in the included studies ranged 31–67.3%. The reasons for this may be the differing states of illness, definitions of positive expression, and race or sex com- position of the sampled populations in the included studies. Therefore, we selected studies where the percentage of high TIMP-2 expression was <50% for subgroup analysis to determine the strength of the previous conclusion. This subgroup analysis also suggested that high TIMP-2 ex- pression in NSCLC patients was a significant predictor of good survival. Thus, we believe that TIMP-2 may be a relatively stable indicator of favorable prognosis in NSCLC.
Mostrar mais

13 Ler mais

Silva Vanessa Sofia Miranda da

Silva Vanessa Sofia Miranda da

Uma vez que a fusão do gene TMPRSS2-ERG tem vindo a revelar uma grande evolução clínica nos últimos tempos, vários estudos demonstram que esta pode ter um papel importante na transformação do epitélio da próstata, sendo considerada como um alvo para a intervenção terapêutica ou diagnóstico, apoiando a sua utilização como biomarcador do CP, através de testes realizados em urina em conjunto com o prostate cancer antigen 3 (PCA3), primeiro biomarcador urinário para o CP (Hessels & Schalken, 2013; Perner et al., 2007; Thangapazham et al., 2014; Wei, 2015).
Mostrar mais

104 Ler mais

Braz. j. .  vol.80 número2

Braz. j. . vol.80 número2

function -sparing surgeries range from transoral laser surgery to supracricoid laryngectomy, all with good quality in speech and swallowing. For those submitted to total laryngectomy, voice could be rehabilitated with insertion of voice prosthe- sis, esophageal voice or electrolarynx. One could bear in mind the analysis of two American cancer registry databases, the SEER (Surveillance, Epidemiology, and end Results) and NCDB (National Cancer Data Base). As almost all cancers of human beings had an increase in ive years disease free survi- val for larynx cancer, this survival is decreasing, probably re- lated to increase in non-surgical options of treatment. 10 Then
Mostrar mais

2 Ler mais

Int. braz j urol.  vol.33 número4

Int. braz j urol. vol.33 número4

This article focuses on the complications of a large cystectomy series of a so-called high-volume center with around 40 cystectomies annually. The complication rate in this series, which is very identical to other large volume series, is roughly around 30%, mortality at 1%. Interestingly, median operative time for ileal conduits was 5.7 hours and for neobladders 6.5 hours.

2 Ler mais

Int. braz j urol.  vol.39 número5

Int. braz j urol. vol.39 número5

The main advantage of RC is the preven- tion of local symptoms such as recurrent hematu- ria, clot retention, upper urinary tract dilatation with renal impairment, and voiding symptoms such as urgency and urge incontinence. Lodde et al. (16) evaluated this particular quality of life as- pect in 24 primary MIBC patients who received bladder preservation therapy. The mean age of these patients was 81 years (range 68-92) with a mean follow-up of 680 days. Mean hospital stay was 109 days (range, 13-253 days) equivalent to 16% of the remaining survival time. Because of local complications, seven patients (29%) ul- timately underwent salvage cystectomy. The au- thors therefore questioned the role of conserva- tive management of patients with primary MIBC (16). These discouraging data are in contrast to the present series where no patient required salva- ge cystectomy and the majority was able to void spontaneously. Although the mean age in Lodde’s series was 81 years, some younger patients were included who were more likely to have undergone salvage cystectomy (16).
Mostrar mais

9 Ler mais

Comparative differences between T1ab and T1em as substages in T1 urothelial carcinoma of the bladder

Comparative differences between T1ab and T1em as substages in T1 urothelial carcinoma of the bladder

cause there was currently a worldwide shortage of BCG. Thirdly, the limited number of patients and fol- low-up period may have played a role in the failure of predictive values of sub-staging of T1 for progres- sion. Another limitation to the study is the relative low number of events (62 recurrences) to perform a reliable multivariable analysis with 9 variables. On the other hand, early progression of the disease can be prevented using second TUR, current intravesical induction, and maintenance treatment protocols. In addition, without progression, early cystectomy was performed to several patients. This intervention could bring about a relative decrease in the numbers of disease progression. In our study, tumour size >3cm, multiplicity, and sub-staging T1b for recurrence was very meaningful in univariate and multivariate anal- yses; however, long-term follow-up might reveal sig- nificant diversity for disease progression. Increased numbers of studies and translation of sub-staging of T1 to molecular pathology can lead to more precise prediction of recurrence and progression.
Mostrar mais

6 Ler mais

Significance of Serum Pepsinogens as a Biomarker for Gastric Cancer and Atrophic Gastritis Screening: A Systematic Review and Meta-Analysis.

Significance of Serum Pepsinogens as a Biomarker for Gastric Cancer and Atrophic Gastritis Screening: A Systematic Review and Meta-Analysis.

Gastric cancer (GC) was the fifth most common cancer and the third leading cause of cancer- related mortality worldwide [1]. In the Asia-Pacific region, the incidence of GC is high in Japan, China, Korea, Singapore, and Malaysia and is low in Thailand, India, New Zealand and Australia[2]. The clinical symptoms in the early stages of GC are not specific; therefore, a large number of patients with early GC do not seek appropriate medical care until the disease has progressed [3], and the prognosis of patients with advanced GC remains poor [4]. GC develops in a stepwise manner, and subjects with precancerous lesions, such as atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia, may be at high risk of eventually developing carci- noma. Subsequently, it is important to improve the prognosis of GC by identifying its high-risk population. The development of tools for the early diagnosis of GC and precancerous lesions of GC is important for reducing mortality, increasing survival rates, and improving quality of life [5]. Endoscopy and biopsy are the reference standards for diagnosis and screening of GC and precancerous lesions of GC, but their use is limited for population-wide screening due to their invasiveness[6, 7]. Subsequently, it is necessary to identify novel, simple, cost-effective and manipulable screening methods for GC and precancerous lesions of GC.
Mostrar mais

23 Ler mais

Limitations of ERAS Study Design

Limitations of ERAS Study Design

Over the past three decades, many studies have demonstrated an improvement in clinical recovery with the incorporation of minimally in- vasive techniques. These improvements have been demonstrated in post-operative pain scores, leng- th of stay and metabolic stress response to sur- gery. While the use of minimally and robot-assis- ted techniques for bladder cancer are still evolving there is certainly potential that perioperative be- nefits may be seen. There is currently a paucity of data regarding incorporation of ERAS progra- ms for robotic radical cystectomy, however those published demonstrated improvements in length of stay. Unfortunately, those studies evaluating ERAS for robotic cystectomy had varying num- ber of elements use (31). The EAU robotic urology section scientific working group consensus also highlighted the need for “core teams” for opera- ting room staffing. Presence of a “core team” has been shown to improve operating room efficiency and thereby potentially improving outcomes (32). While not unique to robotic surgery, the concept of a “core team” may have higher value in robo- tics where the primary surgeon is not at bedside. As a general concept, minimally invasive surgery including robotic cystectomy should be seen as a potential additional element to be incorporated into an ERAS program not to be used in lieu of.
Mostrar mais

6 Ler mais

The Use of Glycomacropeptide in Patients with Phenylketonuria: A Systematic Review and Meta-Analysis

The Use of Glycomacropeptide in Patients with Phenylketonuria: A Systematic Review and Meta-Analysis

In a preclinical study, wild-type and PKU mice were fed diets consisting of 20% protein from casein, AAs, or GMP-AAs. In this study, the GMP-AAs group showed similar growth and significantly reduced concentrations of Phe in plasma and brain compared to those fed by conventional sources [12]. Another study sought to evaluate the effect of three diets (GMP-AAs, AAs, and casein) on plasma amino acids, cytokines, fat and lean mass, and acute energy balance in PKU and wild-type mice. The PKU mice had growth and lean mass similar to the wild-type mice fed GMP-AAs or AAs. However, the GMP-AAs significantly reduced energy expenditure, food intake and plasma Phe concentrations in PKU mice, whereas AAs and casein induced metabolic stress [13]. Neurotransmitter concentrations and behavioural phenotype were found to be similar in PKU mice fed with either GMP-AAs or AAs [14]. In a further animal study, GMP-AAs showed prebiotic properties by positively modulating the gut microbiota, increasing short-chain fatty acids, and reducing inflammatory markers [15]. A study by Solverson et al. [16] reported potential long-term benefits for bone health using GMP-AAs.
Mostrar mais

15 Ler mais

Selenium and lung cancer: a systematic review and meta analysis.

Selenium and lung cancer: a systematic review and meta analysis.

Conversely, SELECT found that selenomethionine alone or in combination vitamin E had no significant effect on the risk of developing lung cancer in a setting of primary prevention: selenium, HR 1.12 (95% CI 0.73–1.72); selenium plus vitamin E, 1.16 (0.76–1.78) [9]. This study was a large, randomized, double blind, placebo controlled, multicenter study conducted in 35,533 men that investigated selenium, vitamin E, both, or placebo primarily for the prevention of prostate cancer, but included rates of lung cancer, other primary cancers, diabetes, cardiovascular events, and death as secondary outcomes. The Linxian, China chemoprevention trial also found no effect from a low dose regimen combining beta carotene, alpha-tocopherol, and selenium at doses one to two times the US recommended daily allowance (RDA) for 5.25 years [39]. In findings presented at the American Society of Clinical Oncology in 2010, Karp reported no significant effects from use of selenium on lung cancer recurrence in resected patients, with a second primary tumor rate of 1.91/ 4.11 per 100-person years in the selenium group and 1.36/3.66 for placebo [40]. Five year progression free survival was 72% for selenium compared to 78% for placebo [40].
Mostrar mais

10 Ler mais

Updated Meta-analysis on the Closure of Patent Foramen Ovale in Reduction of Stroke Rates: the DEFENSE-PFO Trial Does not Change the Scenario

Updated Meta-analysis on the Closure of Patent Foramen Ovale in Reduction of Stroke Rates: the DEFENSE-PFO Trial Does not Change the Scenario

To our knowledge, this is the largest meta-analysis of studies performed to date that provides incremental value by demonstrating that patients seem to benefit from device closures in comparison to medical therapy in the reduction of the rate of stroke. On the other hand, there was an increase in the rates of atrial fibrillation. We did not identify the group of patients with an atrial septal aneurysm as a particular group that benefits from the device closure in the sensitivity analysis, although we identified this variable as a modulation factor of the risk for stroke in the meta-regression. We also observed that the benefit of the device closure in the reduction of the rates of stroke hinges on the rate of effective closure. We did not find evidence that the publication of the DEFENSE-PFO trial changed the scenario in the medical literature.
Mostrar mais

11 Ler mais

Show all 10000 documents...

temas relacionados