S210 Risk of Perforation in Patients With Colorectal Cancer and Metallic Stents Who Received Bevacizumab Compared to Stent Alone or Non-Bevacizumab Chemotherapy: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Bevacizumab (BV) is a monoclonal antibody against vascular endothelial growth factor and is used to treat metastatic colorectal cancer (CRC). Although BV is an effective therapy for CRC and is generally well-tolerated, it can be associated with severe complications such as bowel perforation, gastrointestinal bleeding, or thromboembolism. Self-expanding metallic stents (SEMS) are used in obstructive CRC for palliative or preoperative purposes. There is a paucity of published literature on whether the risk of perforation is increased when chemotherapy - BV-based regimen in particular - is administered to patients with SEMS placement. We performed a systematic review and meta-analysis to determine whether BV-based chemotherapy is associated with higher risk of perforation in patients with SEMS. Methods: A comprehensive literature search was performed from major databases from inception to May 2023. The primary outcome assessed was the risk of perforation in BV+SEMS patients. The secondary outcomes assessed were the risk of bleeding in SEMS patients and non-BV+SEMS patients compared to BV+SEMS cohort. Pooled estimates were calculated using a random-effects model with 95% confidence interval (CI). The statistical analysis was performed by using CMA v 3.0 software (BioStat, Englewood, NJ). Results: There were 11 studies included, with BV+SEMS, SEMS only, and non-BV+SEMS therapies given in 293, 215, and 101 patients respectively. There were 9 retrospective cohort studies, 1 prospective cohort study, and 1 randomized controlled trial. Four studies were conducted in the US, 1 in Korean, and 2 each in Italy, Spain, and Canada. The mean age was 66.69±7.42 years. About 87.20% of patients had SEMS placed in the left colon, 4.89% in the transverse colon, and 7.93% in the right colon. The overall pooled rate of perforation in patients who received BV+SEMS was 18% (95% CI: 10.2%, 29.7%; P = 0.00; I2 = 64) (Figure 1). The risk ratios for developing perforation in BV+SEMS group was 1.56 (95% CI: 0.70, 3.47; P = 0.28; I2 = 0) when compared to SEMS alone group and was 3.52 (95% CI: 0.79, 15.62; P = 0.1; I2 = 42.5) when compared to non-BV+SEMS group. Conclusion: BV appears to increase perforation in CRC patients with SEMS, and is associated with a higher risk of perforation than those who received SEMS alone or SEMS + non-BV chemotherapy. Further randomized controlled trials and comparative analyses are needed to validate the findings of our study.Figure 1.: Forest plot for the pooled rate of perforation in patients who received bevacizumab and metallic stent for obstructive metastatic colorectal cancer.
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 | 0,006 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,014 | 0,034 |
| Bibliométrie | 0,007 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 ».