1.
Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer.
Han, J, Xiao, D, Tan, C, Zeng, X, Hu, H, Zeng, S, Jiang, Q, She, L, Yao, L, Li, L, et al
Cancer control : journal of the Moffitt Cancer Center. 2020;(1):1073274820902271
Abstract
BACKGROUND The FIRE-3 phase III clinical trial demonstrated the marked advantage of prolonging the median overall survival of patients with final RAS wild-type (WT) left-sided metastatic colorectal cancer (mCRC) by 38.3 months after treatment with irinotecan, fluorouracil, and leucovorin (FOLFIRI) plus cetuximab and by 28.0 months after treatment with FOLFIRI plus bevacizumab. However, the substantial cost increase and economic impact of using cetuximab imposes a considerable burden on patients and society. METHODS A Markov model based on the data collected in the FIRE-3 trial was developed to investigate the cost-effectiveness of treating patients with FOLFIRI plus either cetuximab or bevacizumab from the perspective of the Chinese health-care system. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters. RESULTS In our analysis, the total treatment costs in the bevacizumab and cetuximab groups were $92 549.31 and $94 987.31, respectively, and the QALYs gained were 1.58 and 2.05. In the base-case analysis, compared with bevacizumab, left-sided RAS WT patients receiving cetuximab gained 0.47 more QALYs at an ICER of $5187.23/QALY ($3166.23/LY). The 1-way sensitivity analysis showed that the most influential parameter was the cost of cetuximab. Probabilistic sensitivity analysis indicated that the cost-effective probability of cetuximab group was 92.8% under the willingness-to-pay threshold of $24 081. CONCLUSIONS Treatment with FOLFIRI plus cetuximab in Chinese patients with left-sided RAS WT mCRC may improve health outcomes and use financial resources more efficiently than FOLFIRI plus bevacizumab.
2.
Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies.
Wang, J, Huang, L, Gao, Y, Wang, Y, Chen, S, Huang, J, Zheng, W, Bao, P, Gong, Y, Zhang, Y, et al
British journal of sports medicine. 2020;(10):582-591
Abstract
BACKGROUND Few studies have examined the associations between physical activity (PA), sedentary behaviour (SB) and risk of colorectal neoplasia (CN). METHODS We systematically searched Medline, Embase, PsyInfo, Cochrane and other sources from their inception to 30 September 2018 for cohort, case-control and cross-sectional studies that evaluated these associations in asymptomatic, average-risk subjects. Random-effect models were used to estimate relative risks (RRs) of any-type CN, advanced CN, and non-advanced CN, respectively, in individuals with the highest versus the lowest level of PA and SB. Dose-response analyses and subgroup analyses were conducted. The I2 statistic was used to examine heterogeneity among studies. RESULTS We identified 32 observational studies, including 17 cross-sectional studies, 10 case-control studies and five longitudinal studies. PA (highest vs lowest) was inversely associated with risk for any-type CN (n=23 studies) and advanced CN (n=15 studies), with a RR of 0.77 (95% CI=0.71 to 0.83, I2=57.5%) and 0.73 (95% CI=0.63 to 0.82, I2=45.5%), respectively. There was no association between PA and non-advanced CN (n=5 studies). There was an as association between PA and any-type CN in both sexes, and also for the distal colon. We found no dose-response relationship between PA and any-type or advanced CN. Based on three studies identified, SB time (longest vs shortest) was associated with an increased risk of advanced CN (RR=1.24, 95% CI 1.04 to 1.49, I2=14.4%). No publication bias was detected by Begg's test. CONCLUSION We report a 23% lower relative risk of any type of CN and a 27% lower risk of advanced CN in people with the highest level of PA compared with those in the lowest.
3.
A meta-analysis between dietary carbohydrate intake and colorectal cancer risk: evidence from 17 observational studies.
Huang, J, Pan, G, Jiang, H, Li, W, Dong, J, Zhang, H, Ji, X, Zhu, Z
Bioscience reports. 2017;(2)
Abstract
The association between dietary carbohydrate intake and colorectal cancer (CRC) risk remains controversial. We therefore conducted this meta-analysis to assess the relationship between them. A literature search from the databases of PubMed, Embase, Web of Science and Medline was performed for available articles published in English (up to September 2016). Pooled relative risk (RR) with 95% confidence interval (CI) was calculated to evaluate the association between dietary carbohydrate intake and CRC risk. The random-effect model (REM) was selected as the pooling method. Publication bias was estimated using Egger's regression asymmetry test and funnel plot. A total of 17 articles involving 14402 CRC patients and 846004 participants were eligible with the inclusion criteria in this meta-analysis. The pooled RR with 95% CI of dietary carbohydrate intake for CRC, colon cancer and rectum cancer risk were 1.08 (95% CI =0.93-1.23, I2 =68.3%, Pheterogeneity<0.001), 1.09 (95% CI =0.95-1.25, I2 =48.3%) and 1.17 (95% CI =0.98-1.39, I2 =17.8%) respectively. When we conducted the subgroup analysis by gender, the significant association was found in men's populations (summary RR =1.23, 95% CI =1.01-1.57), but not in the women's populations. In the further subgroup analyses for study design and geographic locations, we did not find any association between dietary carbohydrate intake and CRC risk in the subgroup results respectively. No significant publication bias was found either by the Egger's regression asymmetry test or by the funnel plot. This meta-analysis suggested that higher dietary carbohydrate intake may be an increased factor for CRC risk in men populations. Further studies are wanted to confirm this relationship.