Aihua Tan

Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction.

Holmium laser enucleation (HoLEP) is an alternative to transurethral resection (TURP) of the prostate for symptomatic prostatic obstruction.

A meta-analysis of randomized controlled trials comparing chemotherapy plus bevacizumab with chemotherapy alone in metastatic colorectal cancer

PurposeBevacizumab has demonstrated survival benefit in metastatic colorectal cancer (mCRC) patients when combined with chemotherapy. Several randomized clinical studies have evaluated bevacizumab in combination with chemotherapy. Meta-analysis was performed to better assess the efficacy and safety of bevacizumab with chemotherapy for mCRC.Materials and methodsFive clinical trials randomizing a total of 3,103 mCRC patients to chemotherapy alone or to the combined treatment of chemotherapy plus bevacizumab were identified. The efficacy data included progression-free survival (PFS), overall survival (OS), and overall response rate (ORR), and the safety data contained the 60-day all-cause mortality rate, adverse events (AEs), and specific toxicity such as hypertension, thrombosis, bleeding, proteinuria, gastrointestinal perforation, diarrhea, and leucopenia.ResultThere was a significant PFS benefit (P = 0.00; hazards ratio [HR] = 0.66) and OS benefit (P = 0.00; HR = 0.77) in favor of the combined treatment. The ORR was significantly higher on the bevacizumab-containing arm (P = 0.021; relative risk [RR] = 1.5), while CR was comparable between the two arms (P = 0.09). A higher incidence of grade 3/4 AEs, grade 3/4 hypertension, grade 3/4 thromboembolic/thrombotic events, grade 3/4 bleeding, and gastrointestinal perforation was associated with the bevacizumab group. The two treatment groups were similar in terms of grade 3/4 proteinuria, grade 3/4 leukopenia, grade 3/4 diarrhea, and the 60-day all-cause mortality rate.ConclusionThe addition of bevacizumab to chemotherapy confers a clinically meaningful and statistically significant improvement in OS, PFS, and ORR. Its side effects are predictable and manageable and do not compound the incidence or severity of toxicities from chemotherapy.

Meta-Analysis of Incidence and Risk of Hypomagnesemia with Cetuximab for Advanced Cancer

Background: Cetuximab is often used in patients with colorectal cancer, head and neck cancer, and other cancers. Hypomagnesemia is a major adverse event that was often ignored in studies. The aim of this meta-analysis is to gain a better understanding of the overall incidence and risk of hypomagnesemia in patients who received cetuximab-based therapy. Methods: Databases, including Pubmed, EMBASE, The Cochrane Library, American Society of Clinical Oncology (2000–2008), and Web of Science, were searched to identify relevant studies. Eligible studies were prospective phase II/III clinical trials of patients with cancer assigned cetuximab at a dose of 400 mg/m2 i.v. on day 1 and 250 mg/m2 weekly thereafter. The primary endpoint was incidence of hypomagnesemia. Results: Nineteen clinical reports were identified which included a total of 4,559 patients available for analysis, with 3,081 patients assigned cetuximab-based treatment. This result showed a high incidence of grade 3 and 4 hypomagnesemia (5.6%; 95% CI = 3.0–10.2) and a high incidence of all-grade hypomagnesemia associated with cetuximab-based therapy for advanced cancer (36.7%; 95% CI = 22–54.4). Compared with non-cetuximab therapy, cetuximab-based therapy has a higher risk of grade 3 and 4 hypomagnesemia (4.75; 95% CI = 3.661–6.18) and all-grade hypomagnesemia (4.75; 95% CI = 3.661–6.18). Conclusion: Cetuximab-based therapy is associated with a significant risk of hypomagnesemia. Early monitoring and effective management of hypomagnesemia are important for patients that received cetuximab-based therapy.

The effect of aspirin in the recurrence of colorectal adenomas: a meta-analysis of randomized controlled trials.

Purpose  Colorectal adenomas are precursors of most colorectal cancers and are important targets for chemoprevention. Aspirin is thought to play an important role in chemoprevention. However, the role of aspirin in preventing recurrence of adenomas is controversial. We performed a systematic review and meta‐analysis to evaluate the effect of aspirin in preventing the recurrence of colorectal adenoma.

Cetuximab-based therapy versus non-cetuximab therapy for advanced cancer: a meta-analysis of 17 randomized controlled trials

PurposeTo assess the efficacy and safety of cetuximab-based therapy versus non-cetuximab therapy for advanced cancer.MethodsA total of 7,954 patients from 17 randomized controlled trials are identified, with 3,965 patients in the cetuximab group and 3,989 patients in the non-cetuximab group. The outcome was progression-free survival (PFS), overall survival (OS), overall response rate (ORR), and grade 3/4 advent events.ResultsThere was a significant improvement of PFS (HR 0.83, 95%CI 0.78–0.88), OS (HR 0.89, 0.84–0.95), and ORR in the cetuximab group (OR 1.39, 1.22–1.58). In subgroup analysis, in colorectal cancer, there was a significant improvement of PFS (0.72, 0.66–0.78), OS (0.90, 0.81–1.00), and ORR in the cetuximab group (1.36, 1.15–1.60). In head and neck carcinoma, there was a significant improvement of PFS (0.63, 0.54–0.73), OS (0.78, 0.67–0.91), and ORR in the cetuximab group (1.57, 1.15–2.16). In non-small-cell lung cancer, there was a significant improvement of OS (0.86, 0.76–0.96) in the cetuximab group, and no difference on PFS (0.82, 0.64–1.07) and ORR (1.56, 0.85–2.88). In pancreatic cancer, there was no difference on PFS (1.11, 0.97–1.28), OS (1.07, 0.93–1.25), and ORR (0.94, 0.66–1.33). There were higher incidences of grade 3–4 toxicity (OR 1.84), skin-related toxicity (OR 31.80), acneiform rash (OR 30.14), and hypomagnesemia (OR 6.72) in the cetuximab group.ConclusionsCetuximab-based therapy improved PFS and OS, and better ORR versus non-cetuximab therapy. The severe adverse events should be predictable and manageable.

Meta-analysis of the colon J-Pouch vs transverse coloplasty pouch after anterior resection for rectal cancer

Purpose  To evaluate the outcome of colonic J‐pouches (CJP) and transverse colonic pouches (TCPs) after anterior resection for rectal cancer.

Capecitabine plus oxaliplatin vs fluorouracil plus oxaliplatin as first line treatment for metastatic colorectal caner – meta-analysis of six randomized trials

Objective  This meta‐analysis was performed to evaluate the efficacy and safety of capecitabine plus oxaliplatin vs fluorouracil (FU) plus oxaliplatin as first line treatment for metastatic or advanced colorectal cancer.

Meta-analysis of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn's disease (CD)

IntroductionWe performed a meta-analysis to compare the clinical and endoscopic recurrence of medical treatment and placebo treatment for preventing postoperative recurrence in Crohn’s disease.Materials and methodsTrials were located through Medline, Embase, the Cochrane Central Register of Controlled Trials, Ovid, Sciencedirect, and Ingenta electronic databases. From 124 articles screened, 14 were identified as randomized placebo-controlled trials and were included for data extraction. Main outcome measures were clinical recurrence, endoscopic recurrence, and severe endoscopic recurrence. The meta-analysis was performed with the fixed-effects model.ResultFourteen studies with 1,497 participants were analyzed. In the intention-to-treat analysis, medical treatment was associated with a significantly lower incidence of clinical recurrence (relative risk of 0.74, 95% confidence interval 0.64–0.87, P = 0.000], but there were no significant differences in endoscopic recurrence (0.94, 0.83–1.07, P = 0.353) and severe endoscopic recurrence (0.83, 0.60–1.16, P = 0.281) between the two groups. When using per-protocol analysis, the results is similar, medical treatment was associated with a significantly lower incidence of clinical recurrence (0.84, 0.72–0.97, P = 0.020), but there were no significant differences in endoscopic recurrence (0.94, 0.85–1.05, P = 0.268) or severe endoscopic recurrence (0.76, 0.55–1.04, P = 0.084) between the two groups of patients.ConclusionsMedical treatment has a sufficiently beneficial effect on decreasing the risk of clinical postoperative recurrence in patients with CD.

The addition of pioglitazone in type 2 diabetics poorly controlled on insulin therapy: A meta-analysis

AIM To quantify the effect of a pioglitazone on glycemic control and lipid parameters, as well as the risk of adverse events when incorporated into the treatment regimen of patients with type 2 diabetes inadequately controlled on insulin. METHODS The electronic databases PubMed, Embase and The Cochrane Library were searched systematically to identify randomized controlled trials (RCTs) of pioglitazone therapy in patients with type 2 diabetes mellitus (DM) inadequately controlled after treatment with insulin. Data on change of haemoglobin A1C (HbA1c), fasting plasma glucose (FPG), lipid parameters and risk of hypoglycemic, edema events were extracted from each study and pooled according to fixed effect model or random effect model in meta-analyses. RESULTS Four RCTs including 1767 patients were included. The pooled estimate of change in HbA1c from baseline was 1.22% (95% CI 1.01-1.44, p<0.001 vs. baseline) and of change in FPG from baseline was 1.63 mmol/l (95% CI 0.75-2.50, p<0.001 vs. baseline). Pioglitazone significantly increased high-density lipoprotein cholesterol (HDL-c) level (0.2 mmol/L, 95%CI: 0.13-0.28) and low-density lipoprotein cholesterol (LDL-c) level (0.10 mol/L, 95%CI: 0.09-0.17), and lowered triglyceride (TG) level (0.05 mmol/L, 95%CI: 0.01-0.09). The odds of experiencing a hypoglycemic event in pioglitazone-treated arms was significantly higher than comparator treatments (RR=1.57, 95% CI 1.12-2.20, p<0.001). The case was the same with edema (RR=2.42, 95% CI 1.67-3.50, p<0.001). CONCLUSIONS Our study implied that in patients with type 2 DM whose control is inadequate on insulin therapy, the additional pioglitazone could significantly improve glucose metabolism and might have a positive effect on important components of the lipid profile, which may have important implications in reducing the risk of cardiovascular disease, a major long-term complication in type 2 diabetes mellitus. Besides, the adverse events (AEs) were well tolerated.

Cetuximab-based therapy vs noncetuximab therapy in advanced or metastatic colorectal cancer: a meta-analysis of seven randomized controlled trials.

Purpose  A meta‐analysis was performed to assess the efficacy and safety of cetuximab‐based therapy vs noncetuximab therapy in advanced or metastatic colorectal cancer.