Objective To explore the association between the preoperative systemic immune-inflammation index (SII) and prognosis in non-small cell lung cancer (NSCLC) patients. Methods A comprehensive literature survey was performed on PubMed, Web of Science, EMbase, The Cochrane Library, Wanfang, and CNKI databases to search the related studies from inception to December 2021. The hazard ratio (HR) and 95% confidence interval (CI) were combined to evaluate the correlation of the preoperative SII with overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) in NSCLC patients. Results A total of 11 studies involving 9 180 patients were eventually included. The combined analysis showed that high SII levels were significantly associated with worse OS (HR=1.61, 95%CI 1.36-1.90, P<0.001), DFS (HR=1.50, 95%CI 1.34-1.68, P<0.001), and RFS (HR=1.17, 95%CI 1.04-1.33, P<0.001). Subgroup analyses also further verified the above results. Conclusion Preoperative SII is a powerful prognostic biomarker for predicting outcome in patients with operable NSCLC and contribute to prognosis evaluation and treatment strategy formulation. However, more well-designed and prospective studies are warranted to verify our findings.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
Objective To evaluate the efficacy of transcatheter aortic valve implantation (TAVI) for native aortic valve regurgitation. MethodsLiterature from The Cochrane Library, PubMed, EMbase, Cochrane Controlled Trials Registry, ClinicalTrials.gov and China Biomedical Literature Database from January 2002 to May 2021 were searched by computer. The literature on TAVI or transcatheter aortic valve replacement treatment for simple aortic reflux were collected. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the literature. Meta-analysis was performed using STATA 14.0 software. ResultsA total of 15 studies including 1 394 patients were included. The Newcastle-Ottawa Scales of the studies were≥6 points. The success rate of prosthetic valve implantation was 72.0%-100.0%, and there was no report of serious complications such as surgical death, myocardial infarction, and valve annulus rupture. The 30-day all-cause mortality rate was 6.3% [95%CI (3.4%, 9.1%)]. The incidence of stroke within 30 days and the rate of postoperative permanent pacemaker implantation were 2.0% [95%CI (1.0%, 4.0%)] and 6.0% [95%CI (4.0%, 10.0%)], respectively, and were both within acceptable limits. ConclusionFor patients with simple high-risk aortic regurgitation, TAVI can obtain satisfactory treatment effects and has low postoperative complications rate, and it may be a potential treatment option for such patients.
ObjectiveTo systematically review risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment.MethodsPubMed, Web of Science, The Cochrane Library, WanFang Data, VIP, CNKI and CBM were searched from inception to January 2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 studies were included, including 19 case-control studies and 14 cohort studies, all of which had a Newcastle-Ottawa Scale (NOS)≥6. There were 26 636 patients, including 20 283 males and 6 353 females, and there were 9 587 patients in China and 17 049 patients abroad. The results of meta-analysis showed that the following factors could increase the risk for EGAL (P≤0.05), including patient factors (18): age, sex, body mass index (BMI), smoking history, smoking index (≥400), alcohol history, digestive tract ulcer, respiratory disease, lower ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, peripheral vascular disease, arrhythmia, diabetes, hypertension, cerebrovascular disease, celiac trunk calcification and descending aortic calcification; preoperative factors (6): abnormal liver function, renal insufficiency, American Society of Anesthesiologists (ASA) grading, neoadjuvant radiotherapy and preoperative albumin<35 g/L, preoperative lower albumin; intraoperative factors (7): retrosternal route, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, splenectomy; postoperative factors (5): respiratory failure, postoperative arrhythmia, use of fiberoptic bronchoscopy, pulmonary infection, deep venous thrombosis. Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL (P<0.05). However, age≥60 years, upper gastrointestinal inflammation, diffusing capacity for carbon monoxide (DLCO%), thoracic surgery history, abdominal surgery history, glucocorticoid drugs history, neoadjuvant chemoradiotherapy, anastomotic embedding, end-to-end anastomosis, hand anastomosis, intraoperative blood loss and other factors were not significantly correlated with EGAL.ConclusionCurrent evidence suggests that the risk factors for postoperative EGAL include age, sex, BMI, smoking index, alcohol history, peptic ulcer, FEV1/FVC, COPD, diabetes, ASA grading, neoadjuvant radiotherapy, preoperative albumin<35 g/L, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, intraoperative splenectomy, postoperative respiratory failure, postoperative arrhythmia and other risk factors. Neoadjuvant chemotherapy may be the protection factor for EGAL. Due to limited study quality, more high quality studies are needed to verify the conclusion.
ObjectiveThrough comparing the therapeutic efficacy of robot-assisted surgery (RS) and conventional surgery (CS) for mitral valve disease by meta-analysis to guide the choice of clinical operation.MethodsDatabases including The Cochrane Library, PubMed, EMbase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc) and Wanfang Database were searched by computer from inception to June 2020. The literature of efficacy comparison between RS and CS was collected. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and evaluated the quality of the literature. Meta-analysis was performed using RevMan 5.4 software.ResultsWe identified 11 studies of RS versus CS with 4 330 patients. Among them, 2 212 patients underwent RS and 2 118 underwent CS. Meta-analysis demonstrated that compared with the CS, RS had longer cross-clamp time (MD=25.00, 95%CI 15.04 to 34.95, P<0.000 01), cardiopulmonary bypass time (MD=44.11, 95%CI 29.26 to 58.96, P<0.000 01) and operation time (MD=46.40, 95%CI 31.55 to 61.26, P<0.000 01). However, ICU stay (MD=–22.13, 95%CI –31.88 to –12.38, P<0.000 01) and hospital stay (MD=–1.81, 95%CI –2.69 to –0.92, P<0.000 01) were significantly shorter in the RS group; and the incidences of blood transfusion (OR=0.38, 95%CI 0.16 to 0.89, P=0.03) and complications (OR=0.73, 95%CI 0.57 to 0.94, P=0.01) were significantly lower in the RS group.ConclusionAlthough RS has a longer operation time than CS, it has less damage, less bleeding, faster recovery and better curative efficacy.
ObjectiveTo evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-OttawaScale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. ResultsA total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=?22.45, 95%CI ?34.16 to ?10.73, P<0.001), less postoperative chest drainage (MD=?80.29, 95%CI ?144.86 to ?15.72, P=0.010), shorter postoperative drainage time (MD=?0.69, 95%CI ?1.08 to ?0.30, P<0.001), shorter postoperative hospital stay (MD=?1.14, 95%CI ?1.55 to ?0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI ?1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=?0.18, 95%CI ?0.38 to 0.03, P=0.090) were not statistically different between the two groups. ConclusionIn the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.
ObjectiveTo evaluate the survival results of surgical resection (SR) and CT-guided percutaneous ablation (PA) for stageⅠnon-small cell lung cancer (NSCLC).MethodsThe PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, Wanfang databases from inception to June 2021 were searched to collect comparative studies on the survival results between SR and CT-guided PA treatment for stageⅠNSCLC. RevMan 5.3 software was used for statistical analysis of data.ResultsA total of 3 114 patients were included in 11 studies. The results of meta-analysis showed that compared with the PA group, the SR group had a higher 2-year postoperative overall survival (OS) rate (OR=1.44, 95%CI 1.00-2.06, P=0.05), 3-year postoperative OS rate (OR=2.37, 95%CI 1.47-3.81, P<0.001), 5-year OS rate (OR=1.64, 95%CI 1.19-2.28, P<0.01), 5-year progression-free survival rate after operation (OR=2.43, 95%CI 1.54-3.82, P<0.001) and lower local recurrence rate (OR=0.26, 95%CI 0.13-0.54, P<0.001). There were no statistical differences between the two groups in terms of 1-year postoperative OS rate, 1-year, 2-year, and 3-year tumor-related survival rates, 1-year, 2-year tumor-free survival rates, or distant postoperative recurrence rate (P>0.05).ConclusionFor patients with stageⅠNSCLC with optimal basic conditions, surgery is a more appropriate treatment. For patients who cannot withstand surgical injuries or refuse surgery, CT-guided PA is also a potential alternative treatment. However, this conclusion needs to be verified by prospective controlled trials with larger sample sizes and a more rigorous design.
ObjectiveTo compare the mortality in lung cancer patients infected with coronavirus disease 2019 (COVID-19) versus other cancer patients infected with COVID-19. MethodsA computer search of PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database was conducted to compare the mortality of lung cancer and other cancers patients infected with COVID-19 from the inception to December 2021. Two thoracic surgeons independently screened the literature, extracted data, and then cross-checked the literature. After evaluating the quality of the included literature, a meta-analysis was performed on the literature using Review Manager 5.4 software. ResultsA total of 12 retrospective cohort studies were included, covering 3 065 patients infected with COVID-19, among whom 340 patients suffered from lung cancer and the remaining 2 725 patients suffered from other cancers. Meta-analysis results showed that the lung cancer patients infected with COVID-19 had a higher mortality (OR=1.58, 95%CI 1.24 to 2.02, P<0.001). Subgroup analysis results showed that the mortality of two groups of patients in our country was not statistically different (OR=0.90, 95%CI 0.49 to 1.65, P=0.72). Whereas, patients with lung cancer had a higher mortality than those with other cancers in other countries (Brazil, Spain, USA, France, Italy, UK, Netherlands) (OR=1.78, 95%CI 1.37 to 2.32, P<0.001). ConclusionThere is a negligible difference in mortality between lung cancer and other cancers patients who are infected with COVID-19 in our country; while a higher mortality rate is found in lung cancer patients in other countries. Consequently, appropriate and positive prevention methods should be taken to reduce the risk of infecting COVID-19 in cancer patients and to optimize the management of the infected population.
ObjectiveTo explore the association between radiotherapy and the risk of subsequent primary lung cancer in female patients with breast cancer. MethodsThe EMbase, Web of Science, PubMed, CNKI, VIP and WanFang databases were searched from the establishment date to July 1, 2021. The relative risk (RR) with 95% confidence interval (CI) were combined and all statistical analyses were performed by STATA 12.0 software. ResultsA total of 10 publications including 466 510 participates from 14 studies were included. The meta-analysis indicated that radiotherapy was a risk factor for the occurrence of second primary lung cancer among female breast cancer patients [RR=1.45, 95%CI (1.18, 1.78), P<0.001]. Subgroup analysis based on the relative position of breast cancer and lung cancer was conducted and the results demonstrated that radiotherapy only increased the incidence rate of ipsilateral lung cancer [RR=1.27, 95%CI (1.10, 1.45), P=0.001], without significant change of the risk of contralateral lung cancer [RR=1.16, 95%CI (0.77, 1.74), P=0.487]. ConclusionRadiotherapy is one of the risk factors for subsequent primary pulmonary carcinoma among female breast cancer patients, especially for ipsilateral lung carcinoma. However, more high-quality studies are still needed to verify above findings.
ObjectiveTo investigate the effect of perioperative allogeneic blood transfusion on the prognosis of patients with non-small cell lung cancer (NSCLC).MethodsThe databases including PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched for literature about the effects of perioperative allogeneic blood transfusion on the prognosis of patients with NSCLC from the inception to May 2020. Two authors independently screened the literature, extracted and cross-checked data, and negotiated to resolve differences in opinions. Review Manager V5.3 (Cochrane Collaboration, Oxford, UK) software was used for data analysis.ResultsA total of 15 articles were included, including 5 897 patients. There were 1 649 patients in the trial group and 4 248 patients in the control group. The results of meta-analysis showed that the overall survival of the control group was significantly higher than that of the trial group (OR=0.58, 95%CI 0.47-0.70, P<0.000 01). The disease-free survival of the control group was significantly higher than that of the trial group (OR=0.43, 95%CI 0.36-0.52, P<0.000 01). The recurrence rate of the control group was significantly lower than that of the trial group (OR=1.85, 95%CI 1.34-2.55, P=0.000 2).ConclusionPerioperative allogeneic blood transfusion has adverse effects on the recurrence and survival of patients with NSCLC.