Fatality rate of COVID-19 in patients with malignancies: a sytematic review and meta-analysis Dear Editor, With great interest, we read the recently published letter by Ma et al. (2020) 1 who describe the demographics, clinical features, and prognosis of cancer patients with COVID-19 infection. In this study fatality rate of the COVID-19 in patients with malignancies reported as 13.5%. To have a better estimation of fatality rate, in this letter, we aimed to summarize the fatality rate among cancer patients with COVID-19 infection using meta-analysis. It is currently well known that one of the most important risk factors for COVID-19 morbidity and mortality is comorbid conditions, of which, immunosuppression might be the most challenging one. There are limited evidences about the relationship between COVID-19 severity and cancer. However, few available publications indicated more fatality rate and poorer prognosis of this novel virus in cancer patients compared to general population. Also, it has been observed that patients with cancer are more likely to be admitted to the intensive care unit (ICU), to require invasive ventilation, and even more likely to die. 2 Case fatality rate (CFR) is the likelihood of an infection to result in death. We conducted a systematic search on published studies limited to ones between December 30, 2019 and May 7, 2020 in PubMed, EMBASE, and Scopus. EndNote X8.0 0 0 software was used to manage the records and exclude duplicates. We used the search MeSH terms and relevant text-words including (2019 novel coronavirus OR COVID-19 OR SARS-CoV-2 OR nCoV-2019) AND (cancer OR neoplasms OR malignancy OR tumor OR carcinoma) AND (mortality OR fatality OR death). Eligible articles were those that described the case fatality rate (CFR) of COVID-19 in cancer patients. The two investigators (MN, Z MA), independently extracted data from the literature. We extracted the following variables: author, date, age, sex, number of total patients with malignancy, the proportion of death among them in each study. Case fatality was calculated as percentage of patients with cancer and infected by COVID-19 who died within hospitalization period. The meta-analysis was performed using R version 3.2.3. Pooled case fatality rates and their 95% confidence intervals (95% CIs) were used to summarize the weighted effect size for each study grouping variable using the random-effects model. Publication bias was assessed by funnel plot and Egger's test of asymmetry. From all 122 papers, 9 studies reported fatality rate of cancer patients with COVID-19 in hospital. A total of 805 patients from three countries including Iran (n = 1), 3 China (n = 7), 1 , 2 , 4-8 and USA (n = 1) 9 were studied. The most frequent malignancies was breast cancer (n = 95). Two studies didn't report the type of the malignancies. Seven studies reported the mean age of the patients. Among
Surgical resection followed by concurrent radiation therapy and temozolomide (TMZ) chemotherapy is the current standard treatment for glioblastoma multiforme (GBM). The present metaanalysis investigated the impact of prolonged TMZ maintenance therapy (more than 6 cycles) in comparison with standard TMZ maintenance therapy (exactly six cycles) on overall survival (OS) and progression-free survival (PFS) of patients with GBM. A meta-analysis of the literature was conducted using Medline, PubMed, EMBASE and the Cochrane Library in accordance with PRISMA guidelines. Seven articles involving 1018 patients were included. The overall survival was higher in the case group (>6 cycles TMZ) compared to the control group (6 cycles TMZ) (Z=2.375, P=0.018). The lower and upper limits were between 1.002-10.467 months. The case group had higher progression-free survival compared with the control group (Z=3.84; P<0.001). The lower and upper limits were between 2.559-7.894 months. Evidence from this meta-analysis suggests that prolonged TMZ therapy compared to the standard 6-cycle TMZ therapy was associated with higher survival in patients with glioblastoma.
Management of the central nervous system malignancies are among the evolving areas of research and clinical practice requiring a well-coordinated interdisciplinary approach. The neuro-oncology scientific club (NOSC) has tried to cross the links between various disciplines' experts involved in brain tumor care in Iran since 2011. The NOSC's structured collaborative brain tumor registry (BTCR) and the support received from its steering committee and provincial boards have been the key elements for its success and growth so far. This scientific community not only has helped to optimize brain tumor care but provided interdisciplinary research opportunities to its members across Iran. Mashhad's NOSC has been the pioneer in the above. During the 3 rd Mashhad's NOSC meeting held in November 21 st 2013, the interim results from some important local neuro-oncology studies were presented. Some potential opportunities to improve the coordinated interdisciplinary brain tumor care within the province were discussed by neurosurgery, neuroradiology and radiation oncology faculty at this provincial NOSC meeting. Clinical outcome, survival data and prognostic factors in adult and pediatric gliomas over the past several years in Mashhad, the association between methyl guanine methyl transferase (MGMT) methylation status (determined by MSQP or methylation specific quantitative polymerase chain reaction) where among the main studies outlined during this event. We realize that optimized brain tumor management and productive research in neuro-oncology can only be achieved through an integrated approach and strong team work. This is what the NOSC pursues.
Background: People with diabetes or chronic kidney diseases (CKD) are vulnerable to Covid-19. Our aim in this study was to estimate the fatality rate among people with diabetes or CKD infected by Alpha Covid-19 variant. Methods: The authors searched PubMed, Scopus, and Embase from 1/12/2019 to 13/5/2020 to find studies that reported the fatality rate of Alpha Covid-19 variant among patients with diabetes/renal disease. A Random effects model meta-analysis was used to calculate the pooled case fatality rate (CFR). Then, a subgroup analysis was performed according to the sample size to find possible sources of heterogeneity. Results: In total, 22 papers were studied for diabetes and 10 papers for CKD. The pooled CFR was estimated at 23% (95% CI: 0.18, 0.28) among diabetes patients and 31% (95% CI: 0.16, 0.48) among renal patients. High heterogeneity was observed among the studies (Diabetes: I^2=94%, t^2=0.0173, P<0.01), (CKD: I^2=69%, t^2=0.0457, P<0.01). The subgroup analysis indicated that the sample size had a significant effect on fatality rate estimation. In the diabetes patients, the pooled CFR of Alpha Covid-19 variant was 40% (95% CI: 22%-58%; I^2=91%, t^2=0.0797, P<0.01) among the studies with the sample size of less than 52 hospitalized patients. In the studies with equal or more than 52 patients, the pooled CFR was 14% (95% CI: 11%-17%; I^2=88%, t^2=0.0048, P<0.01). In addition, in renal patients, the pooled CFR was 62% (95% CI: 0.06%-100%; I^2=85%, t^2=0.3745, P<0.01) in the studies with less than six hospitalized patients, and the pooled CFR was 23% (95% CI: 16%-31%; I^2=0%, t^2=0.00, P=0.58) among studies with more than 6 patients. Conclusions: People with either diabetes or CKD and infected with Alpha Covid-19 variant had a higher fatality rate in the general population. More care and vaccination is recommended for these patients. It is recommended that we calculate pooled estimation of the case fatality rate of the other variant of COVID-19 such as Beta, Delta, and Omicron in patients with chronic disease.
Background: Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer. Materials and Methods: In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ≥ 60 years) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months. Results: One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node stage (P value<0.001) and disease stage (P=0.003) and tended to have higher tumor grade (P=0.031) and received more frequent (P value <0.001) adjuvant and neoadjuvant chemotherapy compared to those in the control group. There was no statistically significant difference between two groups regarding the local control, disease-free survival and overall survival rates. Conclusions: In this study, we did not find a prognostic impact for adjuvant radiation on oncologic outcomes in elderly women with breast cancer.
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