Factors for a broad technology assessment of comprehensive genomic profiling in advanced cancer, a systematic review.

Comprehensive Genomic Profiling (CGP) allows for the identification of many targets. Reimbursement decision-making is, however, challenging because besides the health benefits of on-label treatments and costs, other factors related to diagnostic and treatment pathways may also play a role. The aim of this study was to identify which other factors are relevant for the technology assessment of CGP and to summarize the available evidence for these factors. After a scoping search and two expert sessions, five factors were identified: feasibility, test journey, wider implications of diagnostic results, organisation of laboratories, and "scientific spillover". Subsequently, a systematic search identified 83 studies collecting mainly evidence for the factors "test journey" and "wider implications of diagnostic results". Its nature was, however, of limited value for decision-making. We recommend the use of comparative strategies, uniformity in outcome definitions, and the inclusion of a comprehensive set of factors in future evidence generation.

Prognostic value of CT characteristics in GEP-NET: A systematic review.

AIM: A range of CT characteristics with potential prognostic value have previously been identified for gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Still, there is no widely accepted consensus on which characteristics should be reported as prognostic factors. This systematic review therefore aims to provide an overview of the available literature regarding CT characteristics and their prognostic significance for GEP-NET patients. MATERIALS AND METHODS: PubMed, Embase, and Scopus/Cochrane Library databases were searched and a forward and backward reference check of the identified studies was executed. Eligible studies were conducted in patients with GEP-NET, and reported on the prognostic significance (in terms of tumor grade, spread of disease, and survival) of CT-based biomarkers. Study selection, quality assessment and data extraction were performed by two reviewers independently, resolving disagreement by consensus. RESULTS: In total, 5074 unique studies were identified, of which 37 were included. Given the paucity of data on GEP-NETs other than PNET, data extraction and analyses was restricted to PNETs. Fourteen CT characteristics were correlated to prognostic outcomes. Larger tumor size, hypo-enhancement, irregular shape and ill-defined margins, presence of locally invasive growth, lymphadenopathy and metastases were predictors of poorer prognosis according to 65-89% of the available studies. Most studies were regarded as having a low (65%) or moderate (24%) risk of bias. CONCLUSION: Evidence regarding prognostic value of CT-based biomarkers for PNETs is limited to heterogeneous, retrospective studies. Nonetheless, heterogeneity in data is more likely to obscure than to overestimate any correlation. Therefore, we feel that the before-mentioned characteristics should be regarded and reported as clinically relevant predictors of poorer prognosis.

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review.

This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = - 3.47, 95% CI - 5.51 to - 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy(pooled SMD = - 0.37, 95% CI - 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI - 0.12 to 0.50).The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).