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Systematic review and meta-analysis of esophageal cancer in Africa:Epidemiology, risk factors, management and outcomes 被引量:10
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作者 Akwi W Asombang Nathaniel Chishinga +6 位作者 Alick Nkhoma Jackson Chipaila Bright Nsokolo Martha Manda-Mapalo Joao Filipe G Montiero Lewis Banda Kulwinder S Dua 《World Journal of Gastroenterology》 SCIE CAS 2019年第31期4512-4533,共22页
BACKGROUND Esophageal cancer(EC)is associated with a poor prognosis,particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease.AIM To provide further understanding of EC ... BACKGROUND Esophageal cancer(EC)is associated with a poor prognosis,particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease.AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity,and socio-economic challenges faced on the African continent.METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology,risk factors,management and outcomes of EC.A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer,and the Cancer in Sub-Saharan reports.We searched EMBASE,PubMed,Web of Science,and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved.Random effects metaanalyses were used to assess heterogeneity between studies and to obtain odds ratio(OR)of the associations between EC and risk factors;and incidence rate ratios for EC between sexes with their respective 95%confidence intervals(CI).RESULTS The incidence of EC is higher in males than females,except in North Africa where it is similar for both sexes.The highest age-standardized rate is from Malawi(30.3 and 19.4 cases/year/100000 population for males and females,respectively)followed by Kenya(28.7 cases/year/100000 population for both sexes).The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old.Meta-analysis shows a strong association with tobacco(OR 3.15,95%CI:2.83-3.50).There was significant heterogeneity between studies on alcohol consumption(OR 2.28,95%CI:1.94-2.65)and on low socioeconomic status(OR 139,95%CI:1.25-1.54)as risk factors,but these could also contribute to increasing the incidence of EC.The best treatment outcomes were with esophagectomy with survival rates of 76.6%at 3 years,and chemo-radiotherapy with an overall combined survival time of 267.50 d.CONCLUSION Africa has high incidence and mortality rates of EC,with preventable and nonmodifiable risk factors.Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption.Management requires a multidisciplinary approach,and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy. 展开更多
关键词 ESOPHAGEAL CANCER in AFRICA ESOPHAGEAL SQUAMOUS cell carcinoma CANCER in AFRICA Systematic review
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Long-term effectiveness of luteinizing hormone-releasing hormone agonist or antiandrogen monotherapy in elderly men with localizect prostate cancer (T1-2) : a retrospective study 被引量:1
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作者 Rupesh Raina Geetu Pahalajani +1 位作者 Ashok Agarwal Craig Zippe 《Asian Journal of Andrology》 SCIE CAS CSCD 2007年第2期253-258,共6页
Aim: To evaluate the long-term effectiveness, side effects and compliance rates of two types of drugs (luteinizing hormone-releasing hormone [LHRH] agonist and antiandrogen) that were used individually to treat pat... Aim: To evaluate the long-term effectiveness, side effects and compliance rates of two types of drugs (luteinizing hormone-releasing hormone [LHRH] agonist and antiandrogen) that were used individually to treat patients with localized prostate cancer (T1-2) at our institution. Methods: Ninety-seven patients who were diagnosed in the period from April 1997 to January 2000 as having clinically localized prostate cancer (T1-2) received either LHRH agonist (leuprolide acetate 7.5 mg/month) monotherapy (group 1, n = 62) or antiandrogen monotherapy (group 2, n = 35; 18 received bicalutamide 50 mg q.d., 13 received nilutamide 150 mg t.i.d, and 4 received flutamide 250 mg t.i.d.). The mean age in both groups was 76 years. Results: The mean follow-up time was (50.8 ±8.5) months in group 1 and (43.1 ± 2.2) months in group 2. Prostate-specific antigen (PSA) levels rose in only 1 of the 62 patients (1.6%) in group 1, and in 20 of the 35 patients (57.1%) in group 2. In group 2, 10 of the 20 patients (50 %) with increasing PSA levels were treated with LHRH salvage therapy, and eight (80%) responded. Hot flashes (54.8%) and lethargy (41.9%) were the most common side effects in group 1. In contrast, nipple-tenderness (40%) and light-dark adaptation (17.1%) were more often seen in group 2. Only 1 of the 62 patients (1.6%) in group 1 switched to another medication because of adverse side effects; whereas 8 of the 35 patients (22.9%) in group 2 did so. Conclusion: Unlike antiandrogen monotherapy, LHRH agonist monotherapy provided long-term durable control of localized prostate cancer (T1-2). It can also be an effective treatment option for patients whose disease failed to respond to antiandrogen monotherapy. The limitations of our study are the lack of health outcomes analysis and a small sample size. 展开更多
关键词 localized prostate cancer ANTIANDROGEN prostate-specific antigen luteinizing hormone-releasing hormone agonist ANDROGEN ablation MONOTHERAPY
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