Meta-analysis, funnel plots and sensitivity analysis

Copas, J. B.; Shi, Jianghong

doi:10.1093/biostatistics/1.3.247

Cited by 399 publications

(415 citation statements)

References 18 publications

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“…I 2 values of >50% or Q test of P-values less than 0.01 represented significant heterogeneity. Publication bias for observational studies was evaluated using Begg's funnel plot and Egger's test (P<0.05 indicated the presence of publication bias) (24)(25)(26). A DerSimonian-Laird (D-L) random-effect model (27) was selected to calculate the pooled HRs for overall survival (OS).…”

Section: Data Collection Methodsmentioning

confidence: 99%

Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis

Xin

Fang

et al. 2017

mol clin onc

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Abstract. Pancreatic cancer risk is reduced by metformin treatment in patients with diabetes. However, the effect of metformin on pancreatic cancer overall survival is unclear. The aim of the present study was to determine the association between metformin and clinical outcomes of pancreatic cancer patients with diabetes. An electronic and manual search was conducted using PubMed, Web of Science, Medline-Ovid and Cochrane Library databases between the beginning and March 31, 2017. A total of 8 studies consisting of 4,293 patients with pancreatic cancer with diabetes were included, comprising 2,033 patients who had received metformin and 2,260 patients who had not. The meta-analysis showed that metformin was associated with a relative survival benefit in pancreatic cancer patients [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.93]. These associations were also observed in subgroups of Asian countries 0.64 (95% CI, 0.52-0.80) and Western countries 0.88 (95% CI, 0.82-0.95), as well as diabetes (no indication of diabetes type). Excluding the studies considered as be prone to immortal time bias resulted in HRs (95% CIs) of 0.86 (0.69-1.07). The results of this study support the notion that the use of metformin may improve the overall survival of patients with pancreatic cancer with concurrent diabetes. However, the proposed beneficial effect of metformin on pancreatic cancer survival may be based on immortal time bias. Further carefully designed studies with high quality are warranted to confirm this efficacy.

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Section: Data Collection Methodsmentioning

confidence: 99%

Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis

Xin

Fang

et al. 2017

mol clin onc

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“…Prespecified subgroup analyses were performed by (1) ethnicity; (2) anovulatory PCOS; and (3) Hardy-Weinberg equilibrium (HWE) in the controls. Sensitivity analysis [20] was performed to assess the consistency of results and the influence of each study on the overall meta-analysis by sequential omission of individual studies. HWE was detected using the goodness-of-fit χ 2 test.…”

Section: Discussionmentioning

confidence: 99%

Lack of association of INS VNTR polymorphism with polycystic ovary syndrome: a meta-analysis

Song

Luo

Peng

et al. 2014

J Assist Reprod Genet

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Purpose An association between the INS VNTR polymorphisms and polycystic ovary syndrome (PCOS) susceptibility has been reported in previous studies, but the results were inconsistent. This study was conducted to explore this association using meta-analysis. Methods PubMed, Embase, and China National Knowledge Infrastructure (CNKI) were searched according to predefined criteria for all relevant studies published up to August 2013. Four genetic models, together with odds ratios (ORs) and 95 % confidence intervals (CI), were calculated. Subgroup analyses were performed by ethnicity, anovulatory PCOS, and Hardy-Weinberg equilibrium (HWE) in the controls. Results In total, 13 case-control studies, including 1,767 cases and 4,108 controls, were included. No significant association was detected in overall population in all models (III/III Conclusions This meta-analysis revealed no significant association between INS VNTR polymorphisms and the risk of PCOS in the overall population, while it supported that variance may be associated with susceptibility to PCOS with anovulation. Further confirmation is needed from more welldesigned and larger studies.

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“…If the data were heterogeneous under the fixed effects model, a random effects model was utilized (20). Through observing asymmetry of funnel plots, publication bias was evaluated qualitatively (21). In a funnel plot, larger studies that provide a more precise estimate of an intervention's effect form the spout of the funnel, whereas smaller studies with less precision form the cone end of the funnel.…”

Section: Methodsmentioning

confidence: 99%

Erythropoietin for cancer-associated malignant anemia: A meta-analysis

Zhao¹,

Wang²,

Liu³

et al. 2017

Molecular and Clinical Oncology

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Abstract. The present study aimed to evaluate the effectiveness of erythropoietin (EPO) for improving cancer-associated malignant anemia. A search was performed for randomized clinical trials, conducted according to the Cochrane manual, using electronic databases including PubMed, EMBASE, the Cochrane Library and ClinicalTrails.gov up to 15 August 2015. A total of 6 eligible studies from 5 articles enrolling a total of 453 patients were entered into the current meta-analysis. Upon EPO treatment, there were significant differences in the change in hemoglobin (HB) levels compared with the placebo at short-term follow-up [mean difference (MD)=0.66; 95% confidence interval (CI), 0.14-1.18; I 2 =Not applicable; P=0.01) and long-term follow-up (MD=0.10; 95% CI, 0.02-0.18; I 2 =Not applicable; P=0.01) under the random effects model. For changes in hematocrit (HCT) compared with the placebo, the results revealed there were significant differences at short-term follow-up (MD=2.47; 95% CI, 0.75-4.19; I 2 =Not applicable; P=0.005) and long-term follow-up (MD=7.60; 95% CI, 6.15-9.05; I 2 =Not applicable; P<0.00001) under the random effects model. Compared with the placebo in short-term follow-up under the fixed effects model with homogeneity, the result was a significant difference for the transfusion ratio [relative risk (RR)=0.81; 95% CI, 0.67-0.97; I 2 =34%; P=0.02) and the transfusion requirements (MD=-0.45; 95% CI, -0.92, 0.03; I 2 =6%; P=0.07). Funnel plots did not detect any publication bias. These results suggest that EPO was beneficial to alleviate cancer-associated anemia and improve survival outcomes for patients with cancer.

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Meta-analysis, funnel plots and sensitivity analysis

Cited by 399 publications

References 18 publications

Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis

Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis

Lack of association of INS VNTR polymorphism with polycystic ovary syndrome: a meta-analysis

Erythropoietin for cancer-associated malignant anemia: A meta-analysis

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