Influence of clinical characteristics and tumor size on symptoms of bladder leiomyoma： a pooled analysis of 61 cases

Background Bladder leiomyoma is an uncommon type of bladder neoplasms. Most publications are reports of isolated cases. The influence of tumor size on patients＇ early symptoms was seldom analyzed. We aim to investigate the clinical characteristics of bladder leiomyoma and the influence of tumor size on patients＇ symptoms in Chinese population. Methods We reviewed the medical records of eight patients diagnosed with bladder leiomyoma at our department, collected 53 cases from Chinese National Knowledge Infrastructure （CNKI）, Wangfang data base, and Chinese Biological Medicine Disk, and performed a pooled analysis. The clinical characteristics of the patients were analyzed and then classified into symptomatic and asymptomatic groups. The association between tumor size and the occurrence of symptoms was evaluated. Furthermore, Logistic regression model was constructed to discriminate variables. Results Women comprised the majority of the patients （49/61, 80.3%）. The mean age and tumor size were （42.3＋14.0） years and （45.0＋25.7） mm, respectively. Among all the symptoms, irritative symptoms occurred most frequently （37.7%, 23/61）, followed by obstructive urinary symptoms （31.1%, 19/61）, hematuria （24.6%, 15/61 ）, and abdominal bulge or pain （14.8%, 9/61）. In our study, patients who were 45 years old or younger tended to be asymptomatic compared with elder ones （14/36 vs. 3/25, P=-0.021）. The histological, as well as anatomical, location of tumor, did not show significant differences between symptomatic and asymptomatic patients （P=-0.306 and 0.700）. Tumors larger than 30 mm in the greatest diameter would cause clinical symptoms such as obstructive urinary symptoms （P=0.048） and irritative symptoms （P=0.037）. Logistic regression confirmed the association between tumor size and the occurrence of symptoms, which was related with age. Conclusions Bladder leiomyoma occurs mainly in women and most frequently with irritative symptoms. The occurrence of symptoms is related to tumor size rather than the location： In this setting, patients with endovesical tumors smaller than 30 mm in the greatest diameter tended to be asymptomatic, which were usually treated with transurethrai resection of bladder tumor.

Match and training injury incidence in rugby league:A systematic review,pooled analysis,and update on published studies

In studies reporting rugby league injuries,match injuries varied depending upon participation level.To review and update pooled data estimates for rugby league injury epidemiology and add information for participation levels in match and training environments.A systematic review and pooled analysis for published studies reporting rugby league match and training injuries.Searches were performed in the PubMed,CINHAL,ScienceDirect,Scopus,SPORTDiscus,SpringerLink,and Wiley Online databases.Studies were considered if they reported on rugby league match or training injuries between Jan 1990 to June 2021.Two authors(DK,TC)extracted the study characteristics,numerical data and assessed the article quality,by adhering to the protocol for systematic review of observational studies(MOOSE)and the STrengthening and Reporting of OBservational studies in Epidemiology(STROBE)statement.The 46 studies included a combined exposure of 419,037 h and 18,783 injuries incorporating 158,003 match-hr and 15,706 match injuries(99.4[95%CI:97.9–101.0]per 1000 match-hr)and 264,033 training-hr and 3077 training injuries(11.8[95%CI:11.4–12.2]per 1000 training-hr).Of included studies,47.9%utilised a medical attention/treatment injury definition.There was a five-fold difference in injuries for the semi-professional participation level(431.6 per 1000 match-hr)compared with professional(RR:4.92;p<0.001)and elite(RR:3.77;p<0.001)participation levels.The hooker recorded the highest pooled injury incidence(93.1 per 1000 match-hr).Compared to the 2014 analysis there was a 10-fold increase for headneck region(RR:10.7;p<0.001)injury incidence,and more injuries for the ball carrier(RR:1.1;p?0.008)and tackler(RR:1.2;p?0.001).There was a three-fold decrease in injury incidence in the first half(RR:2.9;p<0.001)and a two-fold decrease in the second half(RR:2.3;p<0.001)of matches.While rugby league match and training injury incidence had decreased since 2014,the increase in head injuries,and greater injury rate at the semi-professional level,mean further injury prevention interventions are needed.

Clinical features of multiple gastrointestinal stromal tumors:A pooling analysis combined with evidence and gap map

BACKGROUND Multiple gastrointestinal stromal tumors(MGISTs)are a very rare type of gastrointestinal stromal tumor(GIST)and are usually observed in syndrome.AIM The paper aimed to describe the clinical and oncological features of MGISTs and to offer evidence for the diagnosis and treatment.METHODS Data of consecutive patients with MGISTs who were diagnosed at Peking University People’s Hospital(PKUPH)from 2008 to 2019 were retrospectively evaluated.Further,a literature search was conducted by retrieving data from PubMed,EMBASE,and the Cochrane library databases from inception up to November 30,2019.RESULTS In all,12 patients were diagnosed with MGISTs at PKUPH,and 43 published records were ultimately included following the literature review.Combined analysis of the whole individual patient data showed that female(59.30%),young(14.45%),and syndromic GIST(63.95%)patients comprised a large proportion of the total patient population.Tumors were mainly located in the small intestine(58.92%),and both CD117 and CD34 were generally positive.After a mean 78.32-mo follow-up,the estimated median overall survival duration(11.5 years)was similar to single GISTs,but recurrence-free survival was relatively poorer.CONCLUSION The clinical and oncological features are potentially different between MGISTs and single GIST.Further studies are needed to explore appropriate surgical approach and adjuvant therapy.

Treatment outcomes of chemotherapy between unresectable and recurrent biliary tract cancer

AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.

Impact of tumour histological subtype on chemotherapy outcome in advanced oesophageal cancer

To investigate the impact of histology on outcome in advanced oesophageal cancer treated with first-line fluoropyrimidine-based chemotherapy. METHODSIndividual patient data were pooled from three randomised phase III trials of fluoropyrimidine-based chemotherapy ± platinum/anthracycline in patients with advanced, untreated gastroesophageal adenocarcinoma or squamous cell carcinoma (SCC) randomised between 1994 and 2005. The primary endpoint was overall survival of oesophageal cancer patients according to histology. Secondary endpoints were response rates and a toxicity composite endpoint. RESULTSOf the total 1836 randomised patients, 973 patients (53%) were eligible (707 patients with gastric cancer were excluded), 841 (86%) had adenocarcinoma and 132 (14%) had SCC. There was no significant difference in survival between patients with adenocarcinoma and SCC, with median overall survivals of 9.5 mo vs 7.6 mo (HR = 0.85, 95%CI: 0.70-1.03, P = 0.09) and one-year survivals of 38.8% vs 28.2% respectively. The overall response rate to chemotherapy was 44% for adenocarcinoma vs 33% for SCC (P = 0.01). There was no difference in the frequency of the toxicity composite endpoint between the two groups. CONCLUSIONThere was no significant difference in survival between adenocarcinoma and SCC in patients with advanced oesophageal cancer treated with fluoropyrimidine-based chemotherapy despite a trend for worse survival and less chemo-sensitivity in SCC. Tolerance to treatment was similar in both groups. This analysis highlights the unmet need for SCC-specific studies in advanced oesophageal cancer and will aid in the design of future trials of targeted agents.