학술논문
Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews.
Document Type
Academic Journal
Author
Bracchiglione J; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar 46383, Chile.; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Rodríguez-Grijalva G; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Requeijo C; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Santero M; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Salazar J; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Salas-Gama K; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Quality, Process and Innovation Direction, Valld'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain.; Meade AG; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Antequera A; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Auladell-Rispau A; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; Quintana MJ; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Departament de Pediatria, d'Obstetrícia i Ginecologia, i Medicina Preventiva i Salut Pública, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Solà I; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Departament de Pediatria, d'Obstetrícia i Ginecologia, i Medicina Preventiva i Salut Pública, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Urrútia G; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Departament de Pediatria, d'Obstetrícia i Ginecologia, i Medicina Preventiva i Salut Pública, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.; Acosta-Dighero R; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar 46383, Chile.; Bonfill Cosp X; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Departament de Pediatria, d'Obstetrícia i Ginecologia, i Medicina Preventiva i Salut Pública, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
Source
Publisher: MDPI Country of Publication: Switzerland NLM ID: 101526829 Publication Model: Electronic Cited Medium: Print ISSN: 2072-6694 (Print) Linking ISSN: 20726694 NLM ISO Abbreviation: Cancers (Basel) Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2072-6694
Abstract
Background: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs.
Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome.
Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed.
Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.
Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome.
Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed.
Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.