RESUMO
BACKGROUND: Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) is gradually being recognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure. However, most of the studies that have assessed its efficacy and safety were small and heterogeneous. Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence. AIM: To update the efficacy and safety of ECE-LAMS for treatment of biliary obstruction after ERCP failure. METHODS: We searched PubMed, EMBASE, and Scopus databases from the inception of the ECE technique to May 13, 2022. Primary outcome measure was pooled technical success rate, and secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software (version 4.1.3). RESULTS: Fourteen eligible studies involving 620 participants were ultimately included. The pooled rate of technical success was 96.7%, and clinical success was 91.0%. Adverse events were reported in 17.5% of patients. Overall reintervention rate was 7.3%. Subgroup analyses showed results were generally consistent. CONCLUSION: ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible. The consistency of results across most subgroups suggested that this is a generalizable approach.
RESUMO
OBJECTIVES: To determine factors associated with the survival of patients with metastatic recurrent triple-negative breast cancer (mrTNBC). METHODS: Initial metastatic recurrent (during or after therapy) patients with triple-negative breast cancer (TNBC) confirmed by post-operate pathology in the West China Hospital of Sichuan University were followed up. The accumulative survival rates after recurrence were calculated using Kaplan-Meier method and differences were tested using log-rank tests. Cox proportional hazards regression analyses were performed to identify independent predictors of survival rates. RESULTS: A total of 142 patients were included in this study. They were followed up on average 41.9 months (range: 5.1-189.5 months), and had median post-recurrence survival time of 22.0 months.Tumor diameter, lymph node status, TNM stage, disease-free interval (DFI), numbers of recurrent lesions, brain metastasis, liver metastasis and the rapeutic patterns were associated with the survival of patients. The Cox proportional hazards regression model identified multi-lesions recurrence ( P=0.004), DFI≤12 months ( P=0.010), brain metastasis ( P=0.037) and single-modal therapy (SMT) ( P<0.001) as independent risk predictors of post-recurrence survival. In the patients with local recurrence, multi-modal therapy (MMT) had 53.0%post-recurrence 3-year survival rate compared with 11.4% of SMT ( P=0.024). Similar results were also found in the patients with distant metastases (post-recurrence 3-year survival rate 58.1% for MMT versus 29.3% for SMT, P=0.003). CONCLUSIONS: Multi-lesions recurrence, short DFI and brain metastasis are independent risk predictors, while MMT is a protective factor for the survival of patients with mrTNBC.
