A systematic review and meta-analysis of PD-1/PD-L1 inhibitors in specific patient subgroups with advanced gastro-oesophageal junction and gastric adenocarcinoma

BACKGROUND

immune checkpoint inhibitors(ICIs) have shown contradictory results in patients with advanced gastro-oesophageal junction/gastric cancer(GOJ/GC).

AIM

to identify specific patient subgroups that would derive survival benefit from ICIs.

METHODS

a subgroup meta-analysis of randomised clinical trials(RCTs) was carried out.

RESULTS

four phase-III-RCTs were identified with data on the following variables: primary location(Gastric vs GOJ); age(≤ 65 vs >65); gender(male vs female); ECOG PS(0 vs 1); ethnicity (Asian vs non-Asian), histology(intestinal vs diffuse), PD-L1 expression(≥ 1% vs < 1%). PD-L1 positivity was significantly associated with survival benefit from ICIs (HR: 0.82, p 0.047), with a significant interaction between PD-L1 expression and ICI efficacy (interaction HR: 1.41, p 0.02). Numerically, the second most relevant interaction was ICI efficacy and gender, with ICI being more effective in males.

CONCLUSION

The PD-L1 positive patient subgroup derives significant survival benefit from ICI in GOJ/GC, however other predictors are eagerly needed to further refine patient selection.

Prognostic factors associated with the success rates of posterior orthodontic miniscrew implants: A subgroup meta-analysis

OBJECTIVE

To systematically review previous studies and to assess, via a subgroup meta-analysis, the combined odds ratio (OR) of prognostic factors affecting the success of miniscrew implants (MIs) inserted into the buccal posterior region.

METHODS

Three electronic searches that were limited to articles on clinical human studies using MIs that were published in English prior to March 2015 were conducted. The outcome measure was the success of MIs. Patient factors included age, sex, and jaw of insertion (maxilla vs. mandible), while the MI factors included length and diameter. A meta-analysis was performed on 17 individual studies. The quality of each study was assessed for non-randomized studies and quantified using the Newcastle-Ottawa Scale. The meta-analysis outcome was a combined OR. Subgroup and sensitivity analyses based on the study design, study quality, and sample size of miniscrews implanted were performed.

RESULTS

Significantly higher success rates were revealed for MIs inserted in the maxilla, for patients ≥ 20 years of age, and for long MIs (≥ 8 mm) and MIs with a large diameter (> 1.4 mm). All subgroups acquired homogeneity, and the combined OR of the prospective studies (OR, 3.67; 95% confidence interval [CI], 2.10-6.44) was significantly higher in the maxilla than that in the retrospective studies (OR, 2.10; 95% CI, 1.60-2.74).

CONCLUSIONS

When a treatment plan is made, these risk factors, i.e. jaw of insertion, age, MI length, and MI diameter, should be taken into account, while sex is not critical to the success of MIs.

Clinical trials of traditional Chinese medicine in the treatment of diabetic nephropathy--a systematic review based on a subgroup analysis

ETHNOPHARMACOLOGICAL RELEVANCE

The purpose of this study is to systematically evaluate the efficacy of traditional Chinese medicine (TCM) decoctions with different ingredients in the treatment of diabetic nephropathy (DN).

MATERIALS AND METHODS

Papers obtained after the retrieval of randomized controlled clinical trials (RCTs) of TCM treatments of diabetic nephropathy through online database (e.g. Medline, CBM, CNKI, VIP, the online database of Chinese medicine, CDFD, CMFD, and CENTRAL FROM Cochrane Library, etc.) as well as research data in our library. They were published between January 2001 and December 2012. According to the categories of the main TCM ingredients, all the cases in the literature were divided into a liver-kidney YIN deficiency group, a QI-BLOOD YIN-and-YANG deficiency group, and a spleen-kidney YANG deficiency group. Stata 11.0 was applied for subgroup analysis.

RESULTS

A total of 21 Chinese RCTs were included in this review. The Q values of the three groups were 13.18, 0.25 and 3.27, respectively, P>0.05, and thus, there was no clinical heterogeneity. The combined relative risk (RR) value and its 95% confidence interval were 1.48 (1.37, 1.60), 1.19 (1.06, 1.34), and 1.33 (1.19, 1.50), respectively, P<0.05.

CONCLUSIONS

Compared with the qi-blood yin-and-yang deficiency group and the spleen-kidney yang deficiency group, the liver-kidney yin deficiency group has better prospects in clinical application to ensure renal function during the treatment of DN, and this possibility is worthy of further study.