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Article ; Online: Oncological safety of active surveillance for low-risk ductal carcinoma in situ - a systematic review and meta-analysis.

Davey, Matthew G / Lowery, Aoife J / Kerin, Michael J

2022 Volume 192, Issue 4, Page(s) 1595–1600

Abstract: Introduction: Current standard of care for patients diagnosed with "low-risk" ductal carcinoma in situ (DCIS) involves surgical resection. Ongoing phase III clinical trials are hoping to establish the oncological safety of active surveillance (AS) in ... ...

Abstract	Introduction: Current standard of care for patients diagnosed with "low-risk" ductal carcinoma in situ (DCIS) involves surgical resection. Ongoing phase III clinical trials are hoping to establish the oncological safety of active surveillance (AS) in managing "low-risk" DCIS. Aims: To evaluate the oncological safety of AS versus surgery for "low-risk" DCIS. Methods: A systematic review was performed in accordance with PRISMA guidelines. Survival outcomes were expressed as dichotomous variables and reported as odds ratios (OR) with 95% confidence intervals (95% CI) using the Mantel-Haenszel method. Results: Four studies including 9626 patients were included, 3.9% of which were managed using AS (374/9626) and 96.1% with surgery (9252/9626). The mean age of included patients was 50.3 years (range: 30-99 years) and mean follow-up was 6.1 years. Invasive cancer detection after surgery and AS were similar (OR: 0.93, 95% CI: 0.41-2.11, P = 0.860, heterogeneity (I Conclusion: This study outlines the provisional oncological safety of AS for cases of "low-risk" DCIS. While survival outcomes were comparable for both management strategies, ratification of these results in the ongoing phase III clinical trials is still required prior to changes to current management strategies. Prospero registration: CRD42022313241.
MeSH term(s)	Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Watchful Waiting ; Longitudinal Studies ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/pathology
Language	English
Publishing date	2022-09-16
Publishing country	Ireland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-022-03157-w
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Article ; Online: The Impact of Chemotherapy Prescription on Long-Term Survival Outcomes in Early-Stage Invasive Lobular Carcinoma - A Systematic Review and Meta-Analysis.

Davey, Matthew G / Keelan, Stephen / Lowery, Aoife J / Kerin, Michael J

Clinical breast cancer

2022 Volume 22, Issue 8, Page(s) e843–e849

Abstract: Introduction: Invasive lobular carcinoma (ILCs) are typically endocrine responsive breast cancers which respond poorly to chemotherapy. The long-term survival advantage of prescribing chemotherapy in such cases remains unclear. To perform a systematic ... ...

Abstract	Introduction: Invasive lobular carcinoma (ILCs) are typically endocrine responsive breast cancers which respond poorly to chemotherapy. The long-term survival advantage of prescribing chemotherapy in such cases remains unclear. To perform a systematic review and meta-analysis assessing, the impact of prescribing chemotherapy in such patients on long-term disease-free (DFS) and overall (OS) survival outcomes. Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Ten-year DFS and OS were pooled as odds ratios (ORs) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Time-to-effect modelling was performed using the generic inverse variance method. Results: Overall, 9 studies including 28,218 patients were included. The mean follow-up was 74 months (range: 0-150 months) and mean age was 60 years (range: 22-90 years). Of these, 34.7% received chemotherapy (9,797/28,218) and 66.3% did not receive chemotherapy (18,421/28,218). Chemotherapy prescription failed to improve 10-year DFS (OR: 0.89, 95% CI: 0.65-1.23) and OS (OR: 0.92, 95% CI: 0.72-1.18). When using time-to-effect modelling, chemotherapy prescription failed to improve DFS (hazard ratio (HR): 1.01, 95% CI: 0.78-1.31) and OS (HR: 1.07, 95% CI: 0.89-1.27, I Conclusion: This meta-analysis illustrates no long-term survival advantage associated with chemotherapy prescription in the setting of early-stage ILC. In the absence of well-designed, prospective clinical trials evaluating the impact of chemotherapy on long-term outcomes in ILC, these results should be considered by the multidisciplinary team when deciding on the value of systemic chemotherapy prescription in ILC.
MeSH term(s)	Humans ; Middle Aged ; Female ; Breast Neoplasms/pathology ; Carcinoma, Lobular/pathology ; Prospective Studies ; Breast/pathology ; Disease-Free Survival ; Prescriptions
Language	English
Publishing date	2022-09-20
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2106734-X
ISSN	1938-0666 ; 1526-8209
ISSN (online)	1938-0666
ISSN	1526-8209
DOI	10.1016/j.clbc.2022.09.005
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Article ; Online: Intraoperative recurrent laryngeal nerve monitoring versus visualisation alone - A systematic review and meta-analysis of randomized controlled trials.

Davey, Matthew G / Cleere, Eoin F / Lowery, Aoife J / Kerin, Michael J

American journal of surgery

2022 Volume 224, Issue 3, Page(s) 836–841

Abstract: Background: Intraoperative nerve monitoring (IONM) is perceived to reduce recurrent laryngeal nerve injury (RLNI) compared to RLN visualisation alone (VA). We performed a meta-analysis of randomized controlled trials (RCTs) to establish the value of ... ...

Abstract	Background: Intraoperative nerve monitoring (IONM) is perceived to reduce recurrent laryngeal nerve injury (RLNI) compared to RLN visualisation alone (VA). We performed a meta-analysis of randomized controlled trials (RCTs) to establish the value of using IONM instead of RLN VA for patients undergoing thyroidectomy. Methods: A meta-analysis of RCTs was performed as per PRISMA guidelines. RLNI rates were expressed as dichotomous variables and pooled as odds ratios (OR) and associated 95% confidence intervals (CI) using the Mantel-Haenszel method. Results: Eight RCTs with 2521 patients with 4977 nerves at risk were included. Overall, 49.8% of RLNs underwent IONM (2480/4978) and 50.2% underwent VA (2497/4978). Overall RLNI rates were higher for VA (VA: 3.2% (80/2497) vs. IONM: 2.3% (58/2480), OR: 0.72, 95% CI: 0.51-1.02, P = 0.060, I Conclusion: When compared to VA alone, using IONM failed to significantly reduce RLNI rates during thyroid surgery.
MeSH term(s)	Humans ; Monitoring, Intraoperative ; Randomized Controlled Trials as Topic ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Thyroidectomy
Language	English
Publishing date	2022-04-09
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.03.036
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Article ; Online: Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy-Reply.

Quinn, Alanna J / Ryan, Éanna J / Lowery, Aoife J

JAMA otolaryngology-- head & neck surgery

2021 Volume 147, Issue 10, Page(s) 923–924

MeSH term(s)	Humans ; Parathyroid Hormone ; Parathyroid Neoplasms/surgery ; Parathyroidectomy ; Technetium Tc 99m Sestamibi
Chemical Substances	Parathyroid Hormone ; Technetium Tc 99m Sestamibi (971Z4W1S09)
Language	English
Publishing date	2021-09-30
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2021.2252
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Article ; Online: OncotypeDX© Recurrence Score in BRCA mutation carriers: a systematic review and meta-analysis.

Davey, Matthew G / Richard, Vinitha / Lowery, Aoife J / Kerin, Michael J

European journal of cancer (Oxford, England : 1990)

2021 Volume 154, Page(s) 209–216

Abstract: Introduction: There are limited data comparing the OncotypeDX© Recurrence Score (RS) among BRCA mutation carriers and patients with sporadic breast cancer.: Aim: To compare RS results among BRCA mutation carriers and patients with sporadic breast ... ...

Abstract	Introduction: There are limited data comparing the OncotypeDX© Recurrence Score (RS) among BRCA mutation carriers and patients with sporadic breast cancer. Aim: To compare RS results among BRCA mutation carriers and patients with sporadic breast cancer in oestrogen receptor positive (ER+), human epidermal growth factor receptor-2 negative (HER2-) breast cancer. Methods: A systematic review was performed in accordance with PRISMA and MOOSE guidelines. Retrospective cohort studies comparing RS in BRCA mutation carriers and cases of sporadic cancer were included. Dichotomous variables were pooled as odds ratios (ORs) and associated 95% confidence intervals (CIs) using the Mantel-Haenszel method. Results: Five studies involving 4286 patients were included with a mean age of 60 years (range 22-85). Overall, 7.8% were BRCA mutation carriers (333/4286). The mean RS was 18.0 (range 0-71), and the mean RS in BRCA carriers was 25 (range 10-71) versus 18.4 in cases of sporadic disease (range 0-62). Patients with sporadic cancers were more likely to have RS < 18 (OR 0.27, 95% CI 0.14-0.51, P = 0.010). BRCA mutation carriers were more likely to have RS 18-30 (OR 1.74, 95% CI 1.28-2.37, P < 0.001) and RS > 30 (OR 3.71, 95% CI 2.55-5.40, P < 0.001). Conclusion: There is an increased likelihood of high-risk RS among patients with known germline BRCA mutations when compared to patients developing sporadic ER+/HER2-early breast cancer. This study offers insight into genomic testing results within BRCA mutation carriers which may be useful in counselling patients with BRCA mutations in future practice.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/chemistry ; Breast Neoplasms/genetics ; Female ; Genes, BRCA1 ; Genes, BRCA2 ; Heterozygote ; Humans ; Middle Aged ; Mutation ; Receptor, ErbB-2/analysis ; Receptors, Estrogen/analysis ; Young Adult
Chemical Substances	Receptors, Estrogen ; ERBB2 protein, human (EC 2.7.10.1) ; Receptor, ErbB-2 (EC 2.7.10.1)
Language	English
Publishing date	2021-07-17
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	82061-1
ISSN	1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
ISSN (online)	1879-0852
ISSN	0277-5379 ; 0959-8049 ; 0964-1947
DOI	10.1016/j.ejca.2021.06.032
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Zs.A 456: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: MicroRNA Expression Profiles and Breast Cancer Chemotherapy.

Davey, Matthew G / Lowery, Aoife J / Miller, Nicola / Kerin, Michael J

International journal of molecular sciences

2021 Volume 22, Issue 19

Abstract: Breast cancer is the most common malignancy diagnosed in women. Traditionally, radical surgical resection was the cornerstone of breast cancer management, with limited exceptions. In recent times, our enhanced appreciation of the biomolecular ... ...

Abstract	Breast cancer is the most common malignancy diagnosed in women. Traditionally, radical surgical resection was the cornerstone of breast cancer management, with limited exceptions. In recent times, our enhanced appreciation of the biomolecular characteristics of breast cancer has transformed the treatment paradigm to include prescription of chemotherapeutical agents, radiotherapies, targeted therapies, as well as more refined surgical approaches. While treatments with such modalities have enhanced clinico-oncological outcomes for breast cancer patients, the efforts of oncological and translational research have concentrated on the identification of novel biomarkers which may successfully inform prognosis and response to therapies, improve current therapeutic strategies, and enhance prognostication. Mi(cro)RNAs are small, non-coding molecules which are known to play regulatory roles in governing gene expression and cellular activity. Measurement of miRNA expression profiles have been illustrated to inform the response to therapies, such as conventional chemotherapy, and are currently undergoing assessment as means of enhancing treatment strategies with these cytotoxic agents. Herein, this review outlines how chemotherapy prescription has revolutionised breast cancer treatment and illustrates the novel role of miRNAs as biomarkers capable of enhancing current therapeutic strategies using chemotherapy in patients being treated with curative intent for breast cancer.
MeSH term(s)	Antineoplastic Agents/therapeutic use ; Biomarkers, Tumor/genetics ; Breast Neoplasms/drug therapy ; Breast Neoplasms/genetics ; Breast Neoplasms/pathology ; Female ; Gene Expression Profiling ; Gene Expression Regulation, Neoplastic/drug effects ; Humans ; MicroRNAs/genetics ; Prognosis
Chemical Substances	Antineoplastic Agents ; Biomarkers, Tumor ; MicroRNAs
Language	English
Publishing date	2021-10-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms221910812
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Article: Hydrogels: 3D Drug Delivery Systems for Nanoparticles and Extracellular Vesicles.

Chabria, Yashna / Duffy, Garry P / Lowery, Aoife J / Dwyer, Róisín M

Biomedicines

2021 Volume 9, Issue 11

Abstract: Synthetic and naturally occurring nano-sized particles present versatile vehicles for the delivery of therapy in a range of clinical settings. Their small size and modifiable physicochemical properties support refinement of targeting capabilities, immune ...

Abstract	Synthetic and naturally occurring nano-sized particles present versatile vehicles for the delivery of therapy in a range of clinical settings. Their small size and modifiable physicochemical properties support refinement of targeting capabilities, immune response, and therapeutic cargo, but rapid clearance from the body and limited efficacy remain a major challenge. This highlights the need for a local sustained delivery system for nanoparticles (NPs) and extracellular vesicles (EVs) at the target site that will ensure prolonged exposure, maximum efficacy and dose, and minimal toxicity. Biocompatible hydrogels loaded with therapeutic NPs/EVs hold immense promise as cell-free sustained and targeted delivery systems in a range of disease settings. These bioscaffolds ensure retention of the nano-sized particles at the target site and can also act as controlled release systems for therapeutics over a prolonged period of time. The encapsulation of stimuli sensitive components into hydrogels supports the release of the content on-demand. In this review, we highlight the prospect of the sustained and prolonged delivery of these nano-sized therapeutic entities from hydrogels for broad applications spanning tissue regeneration and cancer treatment. Further understanding of the parameters controlling the release rate of these particles and efficient transfer of cargo to target cells will be fundamental to success.
Language	English
Publishing date	2021-11-15
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines9111694
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Article ; Online: Intra-operative nerve monitoring and recurrent laryngeal nerve injury during thyroid surgery: a network meta-analysis of prospective studies.

Cleere, Eoin F / Davey, Matthew G / Young, Orla / Lowery, Aoife J / Kerin, Michael J

Langenbeck's archives of surgery

2022 Volume 407, Issue 8, Page(s) 3209–3219

Abstract: Purpose: Recurrent laryngeal nerve (RLN) injury is a feared complication of thyroid surgery occurring in 1-5% of cases. The present approaches to RLN preservation include RLN visualization with no nerve monitoring (No-NM), intermittent intra-operative ... ...

Abstract	Purpose: Recurrent laryngeal nerve (RLN) injury is a feared complication of thyroid surgery occurring in 1-5% of cases. The present approaches to RLN preservation include RLN visualization with no nerve monitoring (No-NM), intermittent intra-operative nerve monitoring (I-IONM) and continuous intra-operative nerve monitoring (C-IONM). There is ambiguity as to which of these strategies should be the preferred method of RLN preservation. Methods: A systematic review of the PubMed, Embase and the Cochrane Collaboration databases was undertaken with network meta-analysis (NMA) performed according to the PRISMA and Cochrane Collaboration guidelines. A Bayesian NMA was conducted using R packages netmeta with outcomes expressed as odds ratios (ORs) with 95% credible intervals (CrI). Only prospective studies were included. Results: Eighteen studies met inclusion criteria, including 22,080 patients and 40,642 nerves at risk (NAR). Overall, 23,364 NARs (57.5%) underwent I-IONM, 17,176 (42.3%) No-NM and 98 (0.2%) underwent C-IONM. There were no significant differences between groups regarding the incidence of permanent RLN injury following thyroid surgery (I-IONM vs.No-NM, OR 0.84, 95% CrI 0.55-1.19; C-IONM vs. No-NM, OR 0.44, 95% CrI 0.02-5.00). Pooled analysis showed that IONM (I-IONM or C-IONM) demonstrated a protective effect versus No-NM in reducing the incidence of transient RLN injury (OR 0.75, 95% CI 0.59-0.97, p = 0.03). Conclusions: IONM strategies did not significantly reduce the incidence of permanent RLN injury following thyroid surgery. However, the small number of C-IONM NARs limits conclusions that may be drawn. Further well-designed prospective studies will be required to definitively assess the utility of C-IONM.
Language	English
Publishing date	2022-08-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02651-0
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Article ; Online: Pathological complete response as a surrogate to improved survival in human epidermal growth factor receptor-2-positive breast cancer: systematic review and meta-analysis.

Davey, Matthew G / Browne, Ferdia / Miller, Nicola / Lowery, Aoife J / Kerin, Michael J

BJS open

2022 Volume 6, Issue 3

Abstract: Background: Achieving a pathological complete response (pCR) is believed to correlate with oncological outcomes in human epidermal growth factor receptor-2-positive (HER2+) breast cancer. However, informed estimation of this survival advantage is often ... ...

Abstract	Background: Achieving a pathological complete response (pCR) is believed to correlate with oncological outcomes in human epidermal growth factor receptor-2-positive (HER2+) breast cancer. However, informed estimation of this survival advantage is often difficult to quantify. The aim of this study was to evaluate the role of pCR as a biomarker of survival in patients treated with neoadjuvant therapies for HER2+ breast cancer. Methods: A systematic review was performed in accordance with the PRISMA checklist. Data specific to pCR and survival with respect to event-free survival (EFS), recurrence-free survival (RFS) and overall survival (OS) were expressed as hazard ratio (HR) and 95 per cent confidence intervals (c.i.). pCR and survival at yearly intervals after resection were expressed as dichotomous variables using the Mantel-Haenszel method. Results: Overall, 78 clinical studies with 25 150 patients were included in this study. pCR predicted better EFS (HR 0.67, 95 per cent c.i. 0.60 to 0.74; 41 studies), RFS (HR 0.69, 95 per cent c.i. 0.57 to 0.83; 18 studies) and OS (HR 0.63, 95 per cent c.i. 0.56 to 0.70; 29 studies) for patients with HER2+ breast cancer. At 5 years, pCR predicted better EFS (HR 0.37, 95 per cent c.i. 0.30 to 0.48; 19 studies), RFS (HR 0.28, 95 per cent c.i. 0.21 to 0.39; 8 studies) and OS (HR 0.26, 95 per cent c.i. 0.20 to 0.33; 10 studies). Conclusion: This study confirms pCR as an informative surrogate biomarker for enhanced survival and suggests that it may be used as an appropriate endpoint for clinical research.
MeSH term(s)	Biomarkers ; Breast Neoplasms/drug therapy ; Breast Neoplasms/therapy ; ErbB Receptors/therapeutic use ; Female ; Humans ; Neoadjuvant Therapy/methods ; Proportional Hazards Models
Chemical Substances	Biomarkers ; ErbB Receptors (EC 2.7.10.1)
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac028
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Article: The impact of liver resection on survival for patients with metastatic breast cancer - A systematic review and meta-analysis.

Calpin, Gavin G / Davey, Matthew G / Calpin, Pádraig / Browne, Ferdia / Lowery, Aoife J / Kerin, Michael J

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2022 Volume 21, Issue 4, Page(s) 242–249

Abstract: Introduction: There is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM).: Aim: To perform a systematic review and meta-analysis evaluating the role of liver resection for ... ...

Abstract	Introduction: There is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM). Aim: To perform a systematic review and meta-analysis evaluating the role of liver resection for BCLM. Methods: A systematic review was performed as per PRISMA guidelines. Hazard ratio (HR) for overall survival (OS) and standard error was obtained from each study and expressed using the generic inverse variance method, with a corresponding 95% confidence interval (CI). OS outcomes at 1- 3- and 5-years were expressed as dichotomous variables and pooled as odds ratios (OR) using the Mantel-Haenszel method. Results: Nine studies with 1732 patients were included. Of these, 24.5% underwent surgical resection of BCLM (424/1732) and 75.5% did not (1308/1732). Overall, OS was significantly better among those who underwent surgery versus controls (HR: 0.69, 95% CI: 0.59-0.80, P < 0.00001). Mortality rates were significantly reduced at 1-year (7.5% (10/134) vs 20.3% (79/390), OR: 0.25, 95% CI: 0.08-0.74, P = 0.010) and 5-years (54.0% (190/352) vs 75.3% (940/1249), OR: 0.46, 95% CI: 0.25-0.87, P = 0.020) respectively for those undergoing surgery versus controls. Mortality rates at 3 years after surgery were lower than the control group (19.1% (29/152) vs 53.0% (222/419)), however this failed to achieve statistical significance at meta-analysis (OR: 0.32, 95% CI: 0.09-1.12, P = 0.070). Conclusion: Liver resection may be considered at multidisciplinary meetings for those with BCLM and offers a potentially curative option. However, judicious patient selection is crucial prior to making decisions in relation to resection of BCLM.
MeSH term(s)	Humans ; Female ; Breast Neoplasms ; Hepatectomy ; Liver Neoplasms/surgery ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2022-11-01
Publishing country	Scotland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2022.10.001
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