The Effect of Low Molecular Weight Heparin (LMWH) on Cancer Survival. A Systematic Review and Meta-Analysis (MA) of Randomized Trials.
Notice bibliographique
Résumé
Abstract Several studies have supported the existence of an antitumor effect of anticoagulants and several MA of studies comparing unfractionated heparin and LMWH for treatment of venous thromboembolism have suggested that the risk of mortality in the subgroup of cancer patients receiving LMWH might be reduced; however other authors have reported contrary findings. We conducted a systematic review and MA of randomized trials comparing LMWH with placebo/no intervention studying as the main outcome the impact on survival in cancer patients. Data sources were Medline, EMBASE, HEALTHstar, Cochrane Library, and grey literature. Data extraction was done by one reviewer and verified by a second reviewer. Discrepancies were resolved by consensus. Main outcomes were death at 1 year and major bleeding episodes. Secondary outcome was death at 2 years. A MA was done using a DerSimonian and Laird random-effects model with odds ratio (OR) and relative risk (RR) as summary statistics. We conducted a MA of survival rates using censored end-points and a MA of hazard ratios (HR). If not reported, HR were extracted from the survival curves and pooled using the generic inverse variance method (random effects model). 283 potential references were identified and 7 were fully evaluated. Four studies which enrolled 898 patients with solid malignancies (the majority with extensive disease) were included; 3 of the 4 studies included previously treated patients. OR and RR of death are shown in the table. Mortality in cancer patients receiving LMWH versus placebo/no treatment All Patients Patients with advanced disease OR 95% CI P OR 95% CI P OR odds ratio; CI confidence interval; RR relative risk 1-year mortality 0.70 0.49, 1.00 0.05 0.75 0.57, 0.99 0.04 2-year mortality 0.57 0.34, 0.96 0.03 0.59 0.42, 0.84 0.004 RR 95% CI P RR 95% CI P 1-year mortality 0.87 0.77, 0.99 0.04 0.89 0.80, 0.99 0.03 2-year mortality 0.90 0.84, 0.97 0.007 0.92 0.86, 0.98 0.02 The results of the survival meta-analysis showed that the pooled survival proportions at 1 and 2 years were 0.43 and 0.19 for the LMWH and 0.35 and 0.11 for the control group, respectively; differences were statistically significant (1 year p=0.018, 2 year p=0.001). The MA of HR is shown in the figure. Figure Figure There was no increase in major bleeding episodes. Sensitivity analyses including only patients with advanced disease did not modify the findings; an analysis according to tumor type was not conducted due to a lack of information. LMWH improves overall survival in cancer patients independent of the stage. Additional trials are required to define the tumor types, disease stages, and dosing schedules most likely to derive the greatest survival benefit. Since the majority of patients included were previously treated, exploring the benefit of LMWH in newly diagnosed patients is necessary.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,025 | 0,057 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,022 | 0,032 |
| Bibliométrie | 0,010 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».