OBJECTIVE: To evaluate the efficacy of systemic therapies in patients with worse performance status (PS) treated for high-risk non-metastatic prostate cancer (PCa), metastatic hormone-sensitive PCa (mHSPC), and non-metastatic/metastatic castration-resistant PCa (nmCRPC/mCRPC), as there is sparse pooled data showing the effect of PS on oncological outcomes in patients with PCa. METHODS: Three databases were queried in June 2022 for randomised controlled trials (RCTs) analysing patients with PCa treated with systemic therapy (i.e., adding androgen receptor signalling inhibitor [ARSI] or docetaxel [DOC] to androgen-deprivation therapy [ADT]). We analysed the oncological outcomes of patients with PCa with worse PS, defined as Eastern Cooperative Oncology Group PS ≥ 1, treated with combination therapies and compared these to patients with good PS. The main outcomes of interest were overall survival (OS), metastasis-free survival (MFS), and progression-free survival. RESULTS: Overall, 25 and 18 RCTs were included for systematic review and meta-analyses/network meta-analyses, respectively. In all clinical settings, combination systemic therapies significantly improved OS in patients with worse PS as well as in those with good PS, while the MFS benefit from ARSI in the nmCRPC setting was more pronounced in patients with good PS than in those with worse PS (P = 0.002). Analysis of treatment ranking in patients with mHSPC revealed that triplet therapy had the highest likelihood of improved OS irrespective of PS; specifically, adding darolutamide to DOC + ADT had the highest likelihood of improved OS in patients with worse PS. Analyses were limited by the small proportion of patients with a PS ≥ 1 (19%-28%) and that the number of PS 2 was rarely reported. CONCLUSIONS: Among RCTs, novel systemic therapies seem to benefit the OS of patients with PCa irrespective of PS. Our findings suggest that worse PS should not discourage treatment intensification across all disease stages.
- MeSH
- Androgen Antagonists adverse effects MeSH
- Progression-Free Survival MeSH
- Docetaxel therapeutic use MeSH
- Humans MeSH
- Prostatic Neoplasms, Castration-Resistant * drug therapy MeSH
- Prostatic Neoplasms * pathology MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Systematic Review MeSH
The concentrations of twelve heavy metals and trace elements (Cr, Mn, Co, Ni, Cu, As, Cd, Pb, Hg, Zn, Fe, and Al) in bed sediment and river freshwater that received sewage discharge, industrial wastewater inputs and mining residue were discussed. Spatial distribution, intra-annual trends and diffuse flux in 2019 in the middle and lower reaches of Olt River Basin (ORB) were investigated using inductively coupled mass spectrometry (ICP-MS) and atomic absorption spectroscopy (AAS). We applied correlation and principal component analysis (PCA) to quantify metal distribution relationship within environmental factors (pH, air temperature) and organic matter existing in the ORB. Moreover, the 87Sr/86Sr and 206Pb/207Pb isotope ratios analysis was employed to conclude the possible origin of the contamination. PCA analysis categorized metal presence in the four-component model, which explains 91% (May), 92% (July) and 93% (September) of the variance and indicates the potential origins of pollutants. The HCA and correlation analysis emphasized the relationship between trace elements, heavy metals in water and sediments and physicochemical characteristics of water. It was observed a high discrepancy in metal distribution between riverbed sediments and water body. In September, correlation indices highlighted sparse positive relationship with trace elements in water and mainly negative correlation values with trace elements from sediments. The origin of pollutants in sediments and water appear to be both natural and human-related activities. In all seasons increased the total exchangeable concentration of Ni, Cu and Zn in the sediments downstream sewage treatment plants and upstream of dams. The consideration of environmental factors and physicochemical characteristics of water is required to develop strategies for pollution management, assessment and mitigation in the actual condition of climate change. This study evaluated the heavy metals pollution in the Olt River Basin over three periods in 2019 under human-induced changes.
- MeSH
- Water Pollutants, Chemical * analysis MeSH
- Ecosystem MeSH
- Geologic Sediments MeSH
- Environmental Monitoring MeSH
- Metals, Heavy * analysis MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Romania MeSH
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.
- MeSH
- Stroke etiology therapy MeSH
- Fibrinolytic Agents adverse effects MeSH
- Intracranial Hemorrhages chemically induced diagnosis MeSH
- Administration, Intravenous MeSH
- Brain Ischemia complications MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Angiography MeSH
- Magnetic Resonance Imaging MeSH
- Predictive Value of Tests MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Tissue Plasminogen Activator adverse effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
