BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent ...BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.展开更多
Excessive exposure to ultraviolet(UV)radiation harms humans and ecosystems.The level of surface UV radiation had increased due to declines in stratospheric ozone in the late 1970s in response to emissions of chloroflu...Excessive exposure to ultraviolet(UV)radiation harms humans and ecosystems.The level of surface UV radiation had increased due to declines in stratospheric ozone in the late 1970s in response to emissions of chlorofluorocarbons.Following the implementation of the Montreal Protocol,the stratospheric loading of chlorine/bromine peaked in the late 1990s and then decreased;subsequently,stratospheric ozone and surface UV radiation would be expected to recover and decrease,respectively.Here,we show,based on multiple data sources,that the May–September surface UV radiation in the tropics and Northern Hemisphere mid-latitudes has undergone a statistically significant increasing trend[about 60.0 J m^(–2)(10 yr)^(–1)]at the 2σlevel for the period 2010–20,due to the onset of total column ozone(TCO)depletion[about−3.5 DU(10 yr)^(–1)].Further analysis shows that the declines in stratospheric ozone after 2010 could be related to an increase in stratospheric nitrogen oxides due to increasing emissions of the source gas nitrous oxide(N_(2)O).展开更多
基金Supported by The Science and Technology Plan Project of Guangzhou,No.202102010171National Natural Science Foundation。
文摘BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.
基金Funding for this work was provided by the National Natural Science Foundation of China(Grant Nos.42122037,42105016,41975047).
文摘Excessive exposure to ultraviolet(UV)radiation harms humans and ecosystems.The level of surface UV radiation had increased due to declines in stratospheric ozone in the late 1970s in response to emissions of chlorofluorocarbons.Following the implementation of the Montreal Protocol,the stratospheric loading of chlorine/bromine peaked in the late 1990s and then decreased;subsequently,stratospheric ozone and surface UV radiation would be expected to recover and decrease,respectively.Here,we show,based on multiple data sources,that the May–September surface UV radiation in the tropics and Northern Hemisphere mid-latitudes has undergone a statistically significant increasing trend[about 60.0 J m^(–2)(10 yr)^(–1)]at the 2σlevel for the period 2010–20,due to the onset of total column ozone(TCO)depletion[about−3.5 DU(10 yr)^(–1)].Further analysis shows that the declines in stratospheric ozone after 2010 could be related to an increase in stratospheric nitrogen oxides due to increasing emissions of the source gas nitrous oxide(N_(2)O).
