Three databases including Pubmed, EMBASE, and Cochrane library were queried. Manuscripts that met the inclusion criteria were included regardless of publication year, language, sample size or length of follow-up. All steps of the meta-analysis were conducted according to PRISMA and MOOSE guidelines.
Seven manuscripts of 6,222 references were included with a total of 2,899 patients. 1,195 (41%) patients were diagnosed with ALI prior to cancer diagnosis, while 1,704 (59%) patients presented following a cancer diagnosis. Nearly three quarters of ALI events were among patients with cancers of skin and soft tissue (19%), genitourinary (18%), lung (17%), and gastrointestinal (16%) systems. ALI recurrence was similar between the two groups, while major amputation was more likely in patients diagnosed with ALI following a cancer diagnosis (7.4% vs 4.6%; p<0.01). The incidence of mortality at one year was significantly greater in patients with established cancers who presented with ALI compared to patients who presented with ALI prior to a cancer diagnosis (50.6% vs 29.9%; p<0.01). After adjusting for study variability under the random effects model, mortality at one year among all patients was 52.3% (95% CI 37.7%-66.5%). There was no significant heterogeneity (p=0.73) between the two groups of ALI patients that varied by timing in relation to cancer diagnosis.
The one-year mortality following ALI in patients with cancer is greater than 50%. In patients presenting with ALI of unclear etiology, an underlying cancer should be considered.
Copyright © 2021. Published by Elsevier Inc.