AIM: To study the effectiveness of second-linetreatments for advancer gastric cancer by application of Bayesian network meta-analysis.METHODS: Our search covered the literature up to February 2015. The following 6 tre...AIM: To study the effectiveness of second-linetreatments for advancer gastric cancer by application of Bayesian network meta-analysis.METHODS: Our search covered the literature up to February 2015. The following 6 treatments were evaluated:(1) irinotecan(camptothecins);(2) paclitaxel(taxanes class);(3) docetaxel(taxanes);(4) everolimus(mammalian target of rapamycin inhibitors);(5) ramucirumab(vascular endothelial growth factor receptor 2 inhibitors);(6) ramucirumab + paclitaxel. Our methodology was based on standard models of Bayesian network meta-analysis. The reference treatment was best supportive care(BSC). The endpoint was overall survival. Median survival was the outcome measure along with 95% credible intervals. RESULTS: Our search identified a total of 7 randomized controlled trials. These trials included 2298 patients(in 15 treatment arms) in whom a total of 6 active treatments were evaluated as well as BSC. There were 21 head-to-head comparisons(6 direct, 15 indirect). The difference in survival between each of two active treatments(paclitaxel and ramucirumab + paclitaxel) vs BSC was statistically significant, while the other 4 showed no statistical difference. In the 6 head-to-head comparisons between active treatments, no significant survival difference was demonstrated. CONCLUSION: Our results indicate that both paclitaxel monotherapy and ramucirumab + paclitaxel determine a significant prolongation in survival as compared with BSC.展开更多
To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overa...To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overall survival(OS) and progression-free survival(PFS) was determined. Our literature search was essentially based on Pub Med but information sources were scanned. Trials were included if a fluoropyrimidine regimen was given to at least one arm and information on PFS and OS was available. Medians for OS and PFS were our end-points. Covariates included temporal trend, arm allocation and Kirsten rat sarcoma status. In analyzing 130 treatment arms identified through our literature search, meta-regression showed an improvement with time for both OS(P < 0.001) and PFS(P < 0.001). The increase in median OS was from 14.9 mo in 2000 to 18.8 mo in 2012. Likewise, the improvement in PFS was from 5.7 to 8.1 mo. Multivariate analysis confirmed these findings. A post-hoc multivariate analysis was focused on patient arms treated with bevacizumab(n = 17) or without bevacizumab(n = 113); the multivariate-adjusted improvement attributable to bevacizumab was 1.66 mo for OS(P = 0.071) and 1.59 mo for PFS(P = 0.002). Overall, our results indicatethat OS and PFS have improved from 2000 to 2012 but the extent of this improvement is small and seems to have quite a questionable clinical relevance.展开更多
Inadequate yield potential of available varieties and their long growth periods are two of the factors limiting yam （Dioscorea spp.） production. Identifying yield- and maturity-related traits and breeding for them w...Inadequate yield potential of available varieties and their long growth periods are two of the factors limiting yam （Dioscorea spp.） production. Identifying yield- and maturity-related traits and breeding for them will enhance production. Ten morphological/physiological traits： time of shoot emergence, time of tuber initiation, plant height, shoot dry weight, time of shoot senescence, tuber fresh weight （tuber yield）, tuber number/plant, tuber parenchyma colour, tuber dry matter content and tuber dormancy period were assessed in eight accessions of D. alata L. （water yam） on the field in 2008 and 2009. Tuber yield-related traits were identified as shoot dry weight and time of shoot emergence. Shoot dry weight had the strongest positive effect; time of shoot emergence had a negative effect. High yielding accessions had a high shoot dry weight, but were low in tuber dry matter content. Uniform tuber parenchyma colour was the sole trait related to tuber maturity, but early and late senescing accessions did not consistently differ in the trait. TDa 00/00103 is high yielding and early maturing and may be used as a parent for breeding for high yield and early maturity in D. alata.展开更多
A“simplified”figure was proposed in 2011 to summarize the results of controlled trials that evaluate different treatments aimed at the same disease condition.The original criteria for classifying individual binary c...A“simplified”figure was proposed in 2011 to summarize the results of controlled trials that evaluate different treatments aimed at the same disease condition.The original criteria for classifying individual binary comparisons included superiority,inferiority and no significance difference;hence,they did not differentiate between no proof of difference vs proof of no difference.We updated the criteria employed in the original“simplified”figure in order to include this differentiation.A revised version of the simplified figure is proposed and described herein.An example of application is also presented.The example is focused on first-line treatments for paroxysmal atrial fibrillation.Three treatments(medical therapy,cryoballoon ablation,radiofrequency ablation)are compared with one another through direct and indirect comparisons.展开更多
BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 ...BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 and 385 patients,respectively),but their results are discordant.AIM To synthetize the available evidence on the effectiveness of lutetium in pre-treated metastatic castration-resistant prostate cancer;and to test the application of a new artificial intelligence technique that synthetizes effectiveness based on reconstructed patient-level data.METHODS We employed a new artificial intelligence method(shiny method)to pool the survival data of these two trials and evaluate to what extent the lutetium cohorts differed from one another.The shiny technique employs an original reconstruction of individual patient data from the Kaplan-Meier curves.The progression-free survival graphs of the two lutetium cohorts were analyzed and compared.RESULTS The hazard ratio estimated was in favor of the vision trial;the difference was statistically significant(P<0.001).These results indicate that further studies on lutetium are needed because the survival data of the two trials published thus far are conflicting.CONCLUSION Our study confirms the feasibility of reconstructing patient-level data from survival graphs in order to generate a survival statistics.展开更多
AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective coh...AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). RESULTS: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P < 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUSION: Differences in T stage distribution largely explain differences in FIT results between screening and referral cohorts. Therefore, FIT results should be reported according to T stage.展开更多
文摘AIM: To study the effectiveness of second-linetreatments for advancer gastric cancer by application of Bayesian network meta-analysis.METHODS: Our search covered the literature up to February 2015. The following 6 treatments were evaluated:(1) irinotecan(camptothecins);(2) paclitaxel(taxanes class);(3) docetaxel(taxanes);(4) everolimus(mammalian target of rapamycin inhibitors);(5) ramucirumab(vascular endothelial growth factor receptor 2 inhibitors);(6) ramucirumab + paclitaxel. Our methodology was based on standard models of Bayesian network meta-analysis. The reference treatment was best supportive care(BSC). The endpoint was overall survival. Median survival was the outcome measure along with 95% credible intervals. RESULTS: Our search identified a total of 7 randomized controlled trials. These trials included 2298 patients(in 15 treatment arms) in whom a total of 6 active treatments were evaluated as well as BSC. There were 21 head-to-head comparisons(6 direct, 15 indirect). The difference in survival between each of two active treatments(paclitaxel and ramucirumab + paclitaxel) vs BSC was statistically significant, while the other 4 showed no statistical difference. In the 6 head-to-head comparisons between active treatments, no significant survival difference was demonstrated. CONCLUSION: Our results indicate that both paclitaxel monotherapy and ramucirumab + paclitaxel determine a significant prolongation in survival as compared with BSC.
文摘To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overall survival(OS) and progression-free survival(PFS) was determined. Our literature search was essentially based on Pub Med but information sources were scanned. Trials were included if a fluoropyrimidine regimen was given to at least one arm and information on PFS and OS was available. Medians for OS and PFS were our end-points. Covariates included temporal trend, arm allocation and Kirsten rat sarcoma status. In analyzing 130 treatment arms identified through our literature search, meta-regression showed an improvement with time for both OS(P < 0.001) and PFS(P < 0.001). The increase in median OS was from 14.9 mo in 2000 to 18.8 mo in 2012. Likewise, the improvement in PFS was from 5.7 to 8.1 mo. Multivariate analysis confirmed these findings. A post-hoc multivariate analysis was focused on patient arms treated with bevacizumab(n = 17) or without bevacizumab(n = 113); the multivariate-adjusted improvement attributable to bevacizumab was 1.66 mo for OS(P = 0.071) and 1.59 mo for PFS(P = 0.002). Overall, our results indicatethat OS and PFS have improved from 2000 to 2012 but the extent of this improvement is small and seems to have quite a questionable clinical relevance.
文摘Inadequate yield potential of available varieties and their long growth periods are two of the factors limiting yam （Dioscorea spp.） production. Identifying yield- and maturity-related traits and breeding for them will enhance production. Ten morphological/physiological traits： time of shoot emergence, time of tuber initiation, plant height, shoot dry weight, time of shoot senescence, tuber fresh weight （tuber yield）, tuber number/plant, tuber parenchyma colour, tuber dry matter content and tuber dormancy period were assessed in eight accessions of D. alata L. （water yam） on the field in 2008 and 2009. Tuber yield-related traits were identified as shoot dry weight and time of shoot emergence. Shoot dry weight had the strongest positive effect; time of shoot emergence had a negative effect. High yielding accessions had a high shoot dry weight, but were low in tuber dry matter content. Uniform tuber parenchyma colour was the sole trait related to tuber maturity, but early and late senescing accessions did not consistently differ in the trait. TDa 00/00103 is high yielding and early maturing and may be used as a parent for breeding for high yield and early maturity in D. alata.
文摘A“simplified”figure was proposed in 2011 to summarize the results of controlled trials that evaluate different treatments aimed at the same disease condition.The original criteria for classifying individual binary comparisons included superiority,inferiority and no significance difference;hence,they did not differentiate between no proof of difference vs proof of no difference.We updated the criteria employed in the original“simplified”figure in order to include this differentiation.A revised version of the simplified figure is proposed and described herein.An example of application is also presented.The example is focused on first-line treatments for paroxysmal atrial fibrillation.Three treatments(medical therapy,cryoballoon ablation,radiofrequency ablation)are compared with one another through direct and indirect comparisons.
文摘BACKGROUND Lutetium has been shown to be an important potential innovation in pre-treated metastatic castration-resistant prostate cancer.Two clinical trials have evaluated lutetium thus far(therap and vision with 99 and 385 patients,respectively),but their results are discordant.AIM To synthetize the available evidence on the effectiveness of lutetium in pre-treated metastatic castration-resistant prostate cancer;and to test the application of a new artificial intelligence technique that synthetizes effectiveness based on reconstructed patient-level data.METHODS We employed a new artificial intelligence method(shiny method)to pool the survival data of these two trials and evaluate to what extent the lutetium cohorts differed from one another.The shiny technique employs an original reconstruction of individual patient data from the Kaplan-Meier curves.The progression-free survival graphs of the two lutetium cohorts were analyzed and compared.RESULTS The hazard ratio estimated was in favor of the vision trial;the difference was statistically significant(P<0.001).These results indicate that further studies on lutetium are needed because the survival data of the two trials published thus far are conflicting.CONCLUSION Our study confirms the feasibility of reconstructing patient-level data from survival graphs in order to generate a survival statistics.
基金Supported by A Research Grant of Center for Translational Molecular Medicine, The Netherlands, to van Turenhout STGrant of Nycomed B.V., Hoofddorp to "the Amsterdam Gut-club", The Netherlands+1 种基金The Netherlands Organization for Health Research and Development, ZonMW, No. 50-50115-98-060,project 63000004The original trial was registered under IS-RCTN57917442 at Current Controlled Trials (www.controlled-trials.com)
文摘AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). RESULTS: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P < 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUSION: Differences in T stage distribution largely explain differences in FIT results between screening and referral cohorts. Therefore, FIT results should be reported according to T stage.
