F Bolfi1, A F Neves1, C L Boguszewski2, V S Nunes-Nogueira1. 1. Department of Internal Medicine, Botucatu Medical School, State University/UNESP, Sao Paulo, Brazil. 2. Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.
Abstract
OBJECTIVE: To compare the acromegaly mortality rates with those expected for the general population from studies published before and after 2008. METHODS: We performed a systematic review and included observational studies in which the number of deaths observed in acromegaly was compared with the expected mortality for the general population mortality observed/expected (O/E). The following electronic databases were used as our data sources: EMBASE, MEDLINE and LILACS. From the observed and expected deaths, we recalculated all standardized mortality ratios (SMR) and their respective confidence intervals (95% CI), which were plotted in a meta-analysis using the software RevMan 5.3. RESULTS: We identified 2303 references, and 26 studies fulfilled our eligibility criteria. From the 17 studies published before 2008, the mortality in acromegaly was increased, while from the nine studies published after 2008, the mortality was not different from the general population (SMR: 1.35, CI: 0.99-1.85). In six studies where somatostatin analogs (SAs) were used as adjuvant treatment, acromegaly mortality was not increased (SMR: 0.98, CI: 0.83-1.15), whereas in series including only patients treated with surgery and/or radiotherapy, mortality was significantly higher (SMR: 2.11; CI: 1.54-2.91). In studies published before and after 2008, the mortality was not increased in patients who achieved biochemical control, while it was higher in those with active disease. Cancer has become a leader cause of deaths in acromegaly patients in the last decade, period in which life expectancy improved. CONCLUSION: Mortality in acromegaly is normalized with biochemical control and decreased in the last decade with the more frequent use of SAs as adjuvant therapy. Increased life expectancy has been associated with more deaths due to cancer.
OBJECTIVE: To compare the acromegaly mortality rates with those expected for the general population from studies published before and after 2008. METHODS: We performed a systematic review and included observational studies in which the number of deaths observed in acromegaly was compared with the expected mortality for the general population mortality observed/expected (O/E). The following electronic databases were used as our data sources: EMBASE, MEDLINE and LILACS. From the observed and expected deaths, we recalculated all standardized mortality ratios (SMR) and their respective confidence intervals (95% CI), which were plotted in a meta-analysis using the software RevMan 5.3. RESULTS: We identified 2303 references, and 26 studies fulfilled our eligibility criteria. From the 17 studies published before 2008, the mortality in acromegaly was increased, while from the nine studies published after 2008, the mortality was not different from the general population (SMR: 1.35, CI: 0.99-1.85). In six studies where somatostatin analogs (SAs) were used as adjuvant treatment, acromegaly mortality was not increased (SMR: 0.98, CI: 0.83-1.15), whereas in series including only patients treated with surgery and/or radiotherapy, mortality was significantly higher (SMR: 2.11; CI: 1.54-2.91). In studies published before and after 2008, the mortality was not increased in patients who achieved biochemical control, while it was higher in those with active disease. Cancer has become a leader cause of deaths in acromegalypatients in the last decade, period in which life expectancy improved. CONCLUSION: Mortality in acromegaly is normalized with biochemical control and decreased in the last decade with the more frequent use of SAs as adjuvant therapy. Increased life expectancy has been associated with more deaths due to cancer.
Authors: Kevin C Corbit; Camella G Wilson; Dylan Lowe; Jennifer L Tran; Nicholas B Vera; Michelle Clasquin; Aras N Mattis; Ethan J Weiss Journal: JCI Insight Date: 2019-08-08
Authors: Maria Rosaria Ambrosio; Irene Gagliardi; Sabrina Chiloiro; Ana Gonçalves Ferreira; Marta Bondanelli; Antonella Giampietro; Antonio Bianchi; Laura De Marinis; Maria Fleseriu; Maria Chiara Zatelli Journal: Endocrine Date: 2020-02-14 Impact factor: 3.633
Authors: Margaret C S Boguszewski; Cesar L Boguszewski; Wassim Chemaitilly; Laurie E Cohen; Judith Gebauer; Claire Higham; Andrew R Hoffman; Michel Polak; Kevin C J Yuen; Nathalie Alos; Zoltan Antal; Martin Bidlingmaier; Beverley M K Biller; George Brabant; Catherine S Y Choong; Stefano Cianfarani; Peter E Clayton; Regis Coutant; Adriane A Cardoso-Demartini; Alberto Fernandez; Adda Grimberg; Kolbeinn Guðmundsson; Jaime Guevara-Aguirre; Ken K Y Ho; Reiko Horikawa; Andrea M Isidori; Jens Otto Lunde Jørgensen; Peter Kamenicky; Niki Karavitaki; John J Kopchick; Maya Lodish; Xiaoping Luo; Ann I McCormack; Lillian Meacham; Shlomo Melmed; Sogol Mostoufi Moab; Hermann L Müller; Sebastian J C M M Neggers; Manoel H Aguiar Oliveira; Keiichi Ozono; Patricia A Pennisi; Vera Popovic; Sally Radovick; Lars Savendahl; Philippe Touraine; Hanneke M van Santen; Gudmundur Johannsson Journal: Eur J Endocrinol Date: 2022-04-21 Impact factor: 6.558