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Background: Esophageal cancer (EC) is the sixth leading cause of cancer mortality worldwide, with a poor prognosis and a 5-year survival rate of 5% in advanced cases. Objectives: To evaluate the efficacy of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors in EC patients by analyzing phase III clinical trials. Design: A meta-analysis following the PRISMA Statement 2020 guidelines. Methods: PubMed/MEDLINE, Web of Science, and Embase were searched through 6 December 2022, and the analysis was conducted using Review Manager 5.4.3 (Cochrane). Results: Out of 387 studies, 13 phase III clinical trials with 6519 participants were pooled. Overall survival (OS) favored PD-1/PD-L1 inhibitors with a Cohen's d of 0.28 (95% CI: 0.12-0.43; p = 0.0006), and the likelihood of achieving objective response also favored these inhibitors (OR: 2.04, 95% CI: 1.68-2.48; p < 0.0001). Conclusion: This meta-analysis provides strong evidence that PD-1/PD-L1 inhibitors combined with chemotherapy improve OS and objective response rate among patients with advanced EC but do not affect progression-free survival. Trial registration: Open Science Framework: osf.io/y27rx.
Current status of PD-1 and PD-L1 immune checkpoint inhibitors in esophageal cancer: insights from an updated meta-analysis and ongoing clinical trials Esophageal cancer is a significant global health concern with a low survival rate, especially in advanced cases. This study, following rigorous guidelines, analyzed data from 13 clinical trials involving over 6,500 participants to assess the effectiveness of PD-1 and PD-L1 inhibitors. The results suggest that combining these inhibitors with chemotherapy improves overall survival and the likelihood of positive treatment responses in advanced esophageal cancer patients. However, no significant impact on progression-free survival was observed. This meta-analysis provides valuable insights into the current state of immune checkpoint inhibitors for esophageal cancer, offering hope for improved treatment outcomes.
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BACKGROUND: Empathy is regarded as one of the leading elements of good physician-patient relationships, having a strong association with improved patient outcomes. It is an aspect of personality, which is considered to be an essential component in the development of interpersonal understanding and in assisting proficiency in communication. Developing empathy among medical students who are going to become tomorrow's physicians is an important part of medical education. The objective of this study was to measure the mean empathy score of medical students at a private medical college and identify associated factors. METHODS: This cross-sectional study was conducted from January to June 2018 among 569 medical students at a private medical college in Lahore. Toronto empathy questionnaire (TEQ) was used to determine empathy levels among students. Data was analysed in IBM SPSS-20. Mean TEQ scores were calculated. Independent sample t-test and one-way ANOVA were used to determine association between mean Toronto empathy score and socio-demographic variables, significant at a p-value of <0.05. RESULTS: The age of 569 respondents ranged from 17 to 27 years with a mean of 20.82±1.757. There were 317 (55.71%) females; and 312 (54.8%) were residing at home with parents. The overall mean TEQ score was calculated to be 42.57±7.513. The Cronbach's alpha was 0.710. There was a significant association between empathy levels and year of study of the respondents (p<0.001), gender (p<0.001) and students' permanent area of residence (p=0.018). CONCLUSION: Overall mean TEQ score was found to be 42.57±7.513. Statistically significant difference was found between gender, place of residence, year of study and mean empathy scores.
