Clinical features of pulmonary embolism in patients with lung cancer: A meta-analysis.

BACKGROUND: Pulmonary embolism (PE) is correlated with increased mortality among patients with lung cancer (LC). The characteristics of patients with LC presenting with PE have not been fully established, and our meta-analysis aims to comprehensively investigate the clinical characteristics associated with PE in patients with LC to help physicians identify PE earlier in these patients. METHODS: Multiple databases were searched, including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and Wanfang. Odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were used as effect measures for dichotomous and continuous variables, respectively. Moreover, Egger's test, Begg's test and a sensitivity analysis were performed to assess the publication bias and reliability of the articles. RESULTS: In total, 16 studies were included in our meta-analysis. The results indicated that history of chronic obstructive pulmonary disease (OR = 2.59, 95% CI: 1.09, 6.15; P = 0.03), adenocarcinoma (OR = 2.28, 95% CI: 1.88, 2.77; P < 0.01), advanced tumour stage (TNM III-IV vs. I-II, OR = 2.38, 95% CI: 1.99, 2.86; P < 0.01), history of central venous catheter (OR = 1.95, 95% CI: 1.36, 2.78; P < 0.01), history of chemotherapy (OR = 2.32, 95% CI: 1.80, 2.99, P < 0.01), high levels of D-dimer (WMD = 4.31, 95% CI: 2.53, 6.10; P < 0.01) and carcinoembryonic antigen (WMD = 10.30, 95% CI: 9.95, 10.64; P < 0.01) and a low level of partial pressure of oxygen (WMD = -25.97, 95% CI: -31.31, -20.62; P < 0.01) were clinical features of LC patients with PE compared to those without PE. CONCLUSIONS: These results reveal that LC patients with PE have specific clinical features, including but not limited to several cancer- and treatment-related factors, that may help their early identification.

Single-agent maintenance therapy in non-small cell lung cancer: a systematic review and meta-analysis.

BACKGROUND: Can single-agent maintenance therapy be considered as an ideal strategy for non-small cell lung cancer (NSCLC) treatment to achieve prolonged survival and tolerated toxicity? A systematic review and meta-analysis was performed to elucidate this issue. METHODS: The electronic databases were searched for RCTs comparing single-agent maintenance therapy with placebo, best support care or observation. The required data for estimation of response, survival and toxicity were extracted from the publications and the combined data were calculated. RESULTS: Eleven RCTs involving 3686 patients were identified. We found a statistically significant higher probability of tumor response for patients with maintenance therapy versus control patients (OR: 2.80, 95%CI: 2.15 - 3.64). Patients receiving maintenance therapy had significantly longer progression-free survival (PFS) (HR: 0.67, 95%CI: 0.62 - 0.71) and overall survival (OS) (HR: 0.84, 95%CI: 0.78 - 0.90). However, maintenance therapy was associated with more severe toxicities (OR: 6.45, 95%CI: 4.61 - 9.01). CONCLUSION: In patients with advanced NSCLC, the use of single-agent maintenance therapy is associated with higher response rate and significantly prolongs PFS and OS despite of the risk of additional toxicity.

[Preliminary study on the MLVA genotyping of Mycobacterium tuberculosis isolates in Fujian province].

OBJECTIVE: To preliminarily understand the genotyping characteristics regarding the variable number tandem repeats (VNTR) of Mycobacterium tuberculosis clinical isolates so as to provide evidence for the development of tuberculosis control and prevention programs in Fujian province. METHODS: Fifteen VNTR locus sets were used to detect the clinical isolates from the fifth surveillance project on tuberculosis resistance, in Fujian province. BioNumerics version 4.5 were used to analyze the cluster from the results generated by genotyping. RESULTS: 313 Mycobacterium tuberculosis isolates were divided into 9 clusters, including I, II, III, IV, V, VI, VII, VIII and IX, with the number of 220, 9, 48, 2, 1, 3, 10, 10, 10 isolates, respectively. Cluster I was the major lineage, accounting for 70.3% (220/313) of the total. Resistance rates of cluster I isolates to isoniazid, streptomycin, ethambutol and multi-drug-resistant were not statistically different from other clusters (P > 0.05). However, resistance rate to rifampicin (RFP) was significantly higher than that of other isolates of the clusters, 33.2% (73/220) vs. 20.4% (19/93) (P < 0.05). CONCLUSION: The strains isolated from Fujian province showed significant polymorphism on genotyping. Cluster I seemed to be the dominant, calling for the close monitoring program on cluster I strains. RESULTS: from our initial studies demonstrated the existence of significant correlation between cluster I strains and drug resistance to RFP.

CYP1A1 MspI and exon7 gene polymorphisms and lung cancer risk: an updated meta-analysis and review.

BACKGROUND: Many studies have examined the association between the CYP1A1 MspI and exon 7 gene polymorphisms and lung cancer risk in various populations, but their results have been inconsistent. METHODS: To assess this relationship more precisely, a meta-analysis and review were performed. The PubMed, Embase, Web of Science, and CNKI database was searched for case-control studies published up to June 2010. Data were extracted and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Ultimately, 64 studies, comprising 18,397 subjects from 49 case-control studies of the MspI genotype and 18,518 patients from 40 case-control studies of the exon 7 genotype, were included. A significantly elevated lung cancer risk was associated with 2 MspI genotype variants (for type C vs. Type A: OR = 1.26, 95% CI = 1.12-1.42; for types B and C combined vs. Type A: OR = 1.20, 95% CI = 1.13-1.28) in overall population. In the stratified analysis, a significant association was found in Asians, Caucasians, lung SCC, lung AC and Male population, not in mixed population, lung SCLC and female population. However, inconsistent results were observed for CYP1A1 exon7 in our meta-analysis, two variants of the exon 7 polymorphism were associated with a significantly higher risk for lung cancer (for Val/Val vs. Ile/Ile: OR = 1.24, 95% CI = 1.09-1.42; for (Ile/Val +Val/Val) vs. Ile/Ile: OR = 1.15, 95% CI = 1.07-1.24) in overall population. In the stratified analysis, a significant assocation was found in Asians, Caucasians, lung SCC and Female population, not in mixed population, lung AD, lung SCLC and Male population. Additionally, a significant association was found in smoker population and not found in non-smoker populations for CYP1A1 MspI and exon7 gene. CONCLUSIONS: This meta-analysis suggests that the MspI and exon 7 polymorphisms of CYP1A1 correlate with increased lung cancer susceptibility and there is an interaction between two genotypes of CYP1A1 polymorphism and smoking, but these associations vary in different ethnic populations, histological types of lung cancer and gender of case and control population.

Diagnostic performance of integrated positron emission tomography/computed tomography for mediastinal lymph node staging in non-small cell lung cancer: a bivariate systematic review and meta-analysis.

INTRODUCTION: Accurate clinical staging of mediastinal lymph nodes (MLNs) of patients with non-small cell lung cancer (NSCLC) is important in determining therapeutic options and prognoses. Integrated positron emission tomography and computed tomography (PET/CT) scanning is becoming widely used for MLN staging in patients with NSCLC. We performed a bivariate meta-analysis to determine the pooled sensitivity (SEN) and specificity (SPE) of this imaging modality. METHODS: The PubMed/MEDLINE, Embase, and SpringerLink databases were searched for articles related to PET/CT for MLN staging in patients with NSCLC. SEN and SPE were calculated for every study. Hierarchical summary receiver operating characteristic curves were used to summarize overall test performance and assess study quality. Potential between-study heterogeneity was explored by subgroup analyses. RESULTS: Fourteen of 330 initially identified reports were included in the meta-analysis. When we did not consider the unit of analysis, the pooled weighted SEN and SPE were 0.73 (95% confidence interval [CI]: 0.65-0.79) and 0.92 (95% CI: 0.88-0.94), respectively. In the patient-based data analysis, the pooled weighted SEN was 0.76 (95% CI: 0.65-0.84) and the pooled weighted SPE was 0.88 (95% CI: 0.82-0.92). In the MLN-based data analysis, the pooled SEN was 0.68 (95% CI: 0.56-0.78) and the pooled SPE was 0.95 (95% CI: 0.91-0.97). CONCLUSIONS: Integrated PET/CT is a relatively accurate noninvasive imaging technique, with excellent specificity for MLN staging in patients with NSCLC. Nevertheless, current evidence suggests that we should not depend on the results of PET/CT completely for MLN staging in patients with NSCLC.

TNF-308 gene polymorphism is associated with COPD risk among Asians: meta-analysis of data for 6,118 subjects.

Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease in which gene-environment interactions play a critical role in disease onset and progression. The gene encoding tumor necrosis factor (TNF) is one of several candidate loci for the pathogenesis of COPD and is highly polymorphic. A number of studies have investigated the association between the TNF-308 polymorphisms and COPD risk in different populations, and resulted in inconsistent results. A systematic review and meta-analysis of the published studies were performed to gain a clearer understanding of this association. The PubMed, Embase, Web of Science, and CNKI databases were searched for case-control studies published from 1966 to April 2009. Data were extracted and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. Twenty-four eligible studies, comprising 2,380 COPD cases and 3,738 controls, were included in the meta-analysis. The pooled result showed that the TNF-308 polymorphisms were significantly associated with an increased risk of COPD (OR=1.335, 95% CI: 1.172-1.522, for allele A carriers versus G/G; OR=1.330, 95% CI=1.174-1.505, for allele A versus allele G). Subgroup analysis supported the results in the Asian populations, but not in the Caucasian populations. When the analysis was limited to only those studies in which the COPD cases and controls were smokers/ex-smokers, the pooled results supported the conclusion. This meta-analysis suggested that the TNF-308 A allele is a more significant risk factor for developing COPD among Asian populations, but not among Caucasians.

Predictive value of ERCC1 and XPD polymorphism in patients with advanced non-small cell lung cancer receiving platinum-based chemotherapy: a systematic review and meta-analysis.

The published data on the predictive value of polymorphism of ERCC1 and XPD in patients with advanced non-small cell lung cancer receiving platinum-based chemotherapy are inconclusive. To derive a more precise estimation of the relationship, a meta-analysis was performed. Relevant studies were identified by searching the Medline, Embase, CNKI and American Society of Clinical Oncology abstract databases. Inclusion criteria were patients with advanced NSCLC, received platinum-based chemotherapy, evaluation of polymorphism of ERCC1 and XPD and overall response rate (ORR). A total of 12 studies were included in this meta-analysis. For studies evaluating ERCC1 polymorphism at codon 118, the ORR for the wild-type C/C genotype versus the heterozygous C/T and T/T genotype was 2.17 (95% confidence interval (CI), 1.43-3.33; P = 0.000). For studies evaluating XPD Asp312Asn and XPD Lys751Gln, the pooled OR was 1.33 (95% CI, 0.92-1.91; P = 0.13) and 1.02 (95% CI, 0.72-1.45; P = 0.915), respectively. The results indicated that platinum-based chemotherapy sensitivity was significantly associated with polymorphism of ERCC1 C118T. However, XPD Asp312Asn and XPD Lys751Gln were not predictive makers for platinum-based chemotherapy in patients with advanced NSCLC.

ERCC2/XPD Lys751Gln and Asp312Asn gene polymorphism and lung cancer risk: a meta-analysis involving 22 case-control studies.

INTRODUCTION: Published data on the association between XPD Lys751Gln and Asp312Asn gene polymorphism and lung cancer risk are inconclusive. METHODS: To derive a more precise estimation of the relationship, a meta-analysis was performed. RESULTS: A total of 22 studies including 15,507 subjects for XPD Lys751Gln genotype and 13,198 subjects for XPD Asp312Asn genotype were examined. For XPD Lys751Gln genotype, significantly increased lung cancer risk was associated with two variant genotypes (CC versus AA: odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42, p = 0.473 for heterogeneity; C allele carriers versus AA: OR = 1.18, 95% CI = 1.08-1.36, p = 0.732 for heterogeneity). When stratified by ethnicity, significantly increased risks were found among Caucasians but not in Asians. For XPD Asp312Asn genotype, significantly increased lung cancer risk was associated with two variant genotypes (AA versus GG: OR = 1.24, 95% CI = 1.09-1.42, p = 0.104 for heterogeneity; the A allele carriers versus GG: OR = 1.35, 95% CI = 1.13-1.57, p = 0.219 for heterogeneity). When stratified analysis by ethnicity, significantly increased risks were found among Asians but not in Caucasians. In the subgroup analyses by smoking status, there were no significant associations among the nonsmoker subgroup; however, significantly increased lung cancer risks were found in the smoking group. CONCLUSION: This meta-analysis suggests that the XPD Lys751Gln and Asp312Asn gene polymorphisms are associated with lung cancer risk, the C allele of XPD Lys751Gln genotype is an increased risk factor for developing lung cancer among Caucasians and in smokers, and the A allele of XPD 312 genotype is also an increased risk factor among Asians and in smokers.

The role of matrix metalloproteinase 2 on the survival of patients with non-small cell lung cancer: a systematic review with meta-analysis.

To evaluate the prognostic value of matrix metalloproteinase2 (MMP-2) expression in patients with non-small cell lung cancer (NSCLC), the electronic database PubMed, EMBASE were searched for relevant articles. The meta-analysis was finally based on 11 studies that included 1,439 patients, and combined HR was 1.66 (95% confidence intervals (CI: 1.37-2.01). Its effect also appeared significant when the analysis was restricted to tumor cell expression and patients with adenocarcinoma (HR 2.08 (95% CI: 1.24-3.48)). This study supported the fact that MMP-2 could be included in further prospective trials studying prognostic factors in NSCLC.

CYP2E1 Rsa I/Pst I polymorphism is associated with lung cancer risk among Asians.

The genetic polymorphism of CYP2E1 Rsa I/Pst I is thought to have significant effect on lung cancer risk, but the results are inconsistent. In this meta-analysis, we assessed 21 published studies involving 9380 subjects of the association between CYP2E1 Rsa I/Pst I polymorphism and lung cancer risk. For the homozygote c2/c2 and c2 allele carriers (c1/c2+c2/c2), the pooled ORs for all studies were 0.734 (95% CI=0.628-0.847; P=0.035 for heterogeneity) and 0.852 (95% CI=0.777-0.933; P=0.004 for heterogeneity) when compared with the homozygous wild-type genotype (c1/c1). In the stratified analysis by ethnicity, the same significant risks were found among Asians for both the c2 allele carriers and homozygote c2/c2. Among mixed populations, only significant risk was associated with c2 allele carriers. No significant associations were found in all Caucasians genetic models. In the subgroup analyses by pathological types, for lung SC the ORs of the c2 allele carriers and the homozygote c2/c2 were 0.749 (95% CI=0.683-0.813; P=0.247 for heterogeneity) and 0.726 (95% CI=0.662-0.847; P=0.006 for heterogeneity), respectively. In the subgroup analyses by smoking status, there were no significant associations among smokers or non-smokers subgroup. This meta-analysis suggests that CYP2E1 Rsa I/Pst I c2 allele is a decreased risk factor for the developing lung cancer among Asians and lung SC.

[Awareness on SARS and public health emergencies among general publics].

OBJECTIVE: To explore the awareness on sever acute respiratory syndrome (SARS) and public health emergencies among general publics. METHODS: A cluster sampling method was implemented in Harbin and Jiagedaqi district of Daxinanling of Heilongjiang province. Research subjects were divided into three groups as city, township and rural areas and were given questionnaires to fill in. Data was analyzed with Epi-data and SPSS. RESULTS: 2003 available questionnaires were collected. The general publics well understood the knowledge on public health emergencies and the SARS with the whole recognition rate more than 60 percent. During the epidemics, people in city, town and countryside were calm (71.7%). The rates of attitude towards the government were significantly different among the subjects living with the city, town or rural areas. The city group expressed the highest favor to the government and media, 71.8% of them gave the credit on the control of SARS to the effective method taken by the government and 65.0% of them showed that they had enough confidence on the governmental ability of dealing with crises while the countryside group trusted the hospitals and relative specialists the most. CONCLUSION: It is essential for the government to interact and communicate with the publics through media, medical and related institutions when confronting with the public health emergencies. Publicity on health knowledge and coping system on emergency should play key roles in the development of an effective public health system while the government should lead the battle.