Kitty Hardman, Anna Davies, Andrew Demetri, Gemma Clayton, Danya Bakhbakhi, Katherine Birchenall, Sonia Barnfield, Abigail Fraser, Christy Burden, Sheelagh McGuinness, Rachel Miller, Abi Merriel
Maternity healthcare professionals' experiences of supporting women in decision-making for labour and birth: a qualitative study
BMJ open
microsatellite instability msi status tumourinfiltrating lymphocytes til established prognostic factors colorectal cancer previous studies evaluating combination til msi status identified distinct colorectal cancer subtypes unique prognostic associations however studies often limited sample size particularly msihigh msih tumours comprehensive summary available evidence aimed review literature compare survival outcomes associated subtypes derived integrated msitil classification patients colorectal cancer systematic review network metaanalysis searched pubmed embase scopus cochrane library without language restrictions articles published jan 1 1990 march 13 2024 patient cohorts comparing different combinations til high low msi status msi microsatellite stable mss patients surgically resected colorectal cancer included studies excluded focused neoadjuvant therapy immune markers b cells macrophages methodological quality assessment done newcastleottawa scale data appraisal extraction done independently two reviewers summary estimates extracted published reports primary outcomes overall survival diseasefree survival cancerspecific survival frequentist network metaanalysis done compare hazard ratios hrs 95 ci outcome msitil subgroups prognostically ranked based pscore bias magnitude precision associations outcome protocol registered prospero crd42023461108 302 studies initially identified 21 studies comprising 14 028 patients included systematic review 19 13 029 patients metaanalysis nine studies identified low risk bias remaining ten moderate risk bias msitilhigh msitilh subtype exhibited longer overall survival hr 045 95 ci 034061 i2777 diseasefree survival 043 032058 i2616 cancerspecific survival 053 043066 i20 followed msstilh subtype overall survival hr 053 041069 i2777 diseasefree survival 052 041064 i2616 cancerspecific survival 055 047064 i20 patients msstillow tumours msstill patients msitill subtype similar overall survival 088 066118 i2777 diseasefree survival 093 069126 i2616 modestly longer cancerspecific survival 072 057090 i20 msstill subtype results direct indirect evidence strongly congruous findings network metaanalysis suggest better survival observed among patients tilh colorectal cancer regardless msi mss status integrated msitil classification explored predictive tool clinical decisionmaking earlystage colorectal cancer german research council ho 511722