Multiple Search Strategies Research Articles

Women's access to family planning services is highly variable at obstetrics and gynecology clinics affiliated with catholic hospitals

Objectives: We aimed to understand women's experiences calling to arrange access to family planning services at obstetrics and gynecology (ob-gyn) clinics that are affiliated with Catholic hospitals. Methods: In this national survey, we determined the number of ob-gyn clinics to call in each state based on population densities and used multiple online search strategies to confirm Catholic hospital affiliations. Using a mystery caller approach, we requested appointments for birth control, including the copper IUD, tubal ligation and abortion. We documented responses and whether referrals were given. Results: We completed calls between December 2014 and February 2016. Of the 144 clinics included, 31.2% of patient care coordinators reported that their clinic was Catholic owned. In response to appointment requests, 95% offered birth control, 68.1% offered copper IUD, 58.3% offered tubal ligation and 2.1% offered abortion. Catholic-owned clinics were less likely than Catholic-affiliated clinics to offer appointments for birth control (84.4% vs. 100%, p<.001), copper IUD (4.4% vs. 97%, p<.001) and tubal ligation (28.9% vs. 71.7%, p<.001). When services were denied, 52.2% did not offer a birth control/IUD referral, 41.7% did not offer a tubal ligation referral and 41.8% did not offer an abortion referral. Conclusions: Women's access to family planning services is highly variable within and throughout ob-gyn clinics in the US that are affiliated with Catholic hospitals. Access mostly depends on the specific service and whether the clinic is Catholic owned or Catholic affiliated. This highly variable access to needed care makes it difficult for women to act as informed health care consumers.

HER3, but Not HER4, Plays an Essential Role in the Clinicopathology and Prognosis of Gastric Cancer: A Meta-Analysis.

Background and AimHuman epidermal growth factor receptor (HER) family plays an important role in gastric cancer (GC), especially HER2. Too much attention has been paid to HER2; however, the functions of HER3 and HER4 overexpression in GC are always ignored. The clinicopathological and prognostic roles of HER3 and HER4 in GC are controversial. In this study, a systematic review and meta-analysis was conducted to evaluate the use of HER3 or HER4 as a predictor of clinicopathology and survival time in GC patients.MethodsEligible studies were searched on PubMed, Ovid, Web of Science, and Cochrane databases through multiple search strategies. Data collection and statistical analysis were carried out by the Revman 5.3 software. The Newcastle-Ottawa scale was used to assess the quality of included studies.ResultsA total of 448 studies about HER3 overexpression and GC, and 398 studies about HER4 overexpression and GC were searched. Of these, 5 eligible studies about HER3 including 1016 GC patients and 3 eligible studies about HER4 including 793 GC patients met the inclusion criteria. The results showed that HER3 and HER4 overexpression were significantly associated with depth of tumor invasion (OR = 0.44, 95%CI 0.29–0.67, P = 0.0002 and OR = 0.50, 95%CI 0.38–0.86, P = 0.007) and lymph node metastasis (OR = 0.40, 95%CI 0.20–0.77, P = 0.007 and OR = 0.57, 95%CI 0.38–0.86, P = 0.007), and HER3 overexpression reveals a tendency of later tumor node metastases (TNM) stage (OR = 0.50, 95%CI 0.22–1.15, P = 0.10) and predicts a worse survival time (RR = 0.71, 95%CI 0.61–0.84, P<0.00001), while HER4 overexpression had no correlation with TNM stage (OR = 0.60, 95%CI 0.20–1.78) and survival time (RR = 1.09, 95%CI 0.91–1.30).ConclusionsThis meta-analysis indicated that HER3 plays an essential role in the clinicopathology and prognosis of GC. However, HER4 may not be an ideal prognostic factor for GC.

Restarting and recentering genetic algorithm variations for DNA fragment assembly: The necessity of a multi-strategy approach

DNA Fragment assembly – an NP-Hard problem – is one of the major steps in of DNA sequencing. Multiple strategies have been used for this problem, including greedy graph-based algorithms, deBruijn graphs, and the overlap-layout-consensus approach.This study focuses on the overlap-layout-consensus approach. Heuristics and computational intelligence methods are combined to exploit their respective benefits. These algorithm combinations were able to produce high quality results surpassing the best results obtained by a number of competitive algorithms specially designed and tuned for this problem on thirteen of sixteen popular benchmarks.This work also reinforces the necessity of using multiple search strategies as it is clearly observed that algorithm performance is dependent on problem instance; without a deeper look into many searches, top solutions could be missed entirely.

Intelligent Multiple Search Strategy Cuckoo Algorithm for Numerical and Engineering Optimization Problems

This paper presents intelligent multiple search strategy algorithm (IMSS) as a new modification of cuckoo search (CS) to improve performance of the conventional algorithm. To do so, the proposed IMSS algorithm adopts a multiple search strategy and Q-learning technique. The introduced multiple search strategy couples CS and covariance matrix adaptation evolution strategy (CMAES) to explore search space more efficiently and also to reduce computational time of finding the optimal solution. More precisely, CS enables the IMSS to achieve better accuracy of final solutions through Levy flights, and CMAES enhances its convergence rate via a concept known as evolution path. To provide an intelligent balance between the exploration and exploitation behaviors, the IMSS employs Q-learning method and thereby acquires information about the performance of each search strategy. Then, it uses this information to dynamically select the best strategy for evolving candidate solutions as optimization process progress. In other words, the IMSS algorithm transforms the task of learning the optimal policy in Q-learning into the search for an efficient and adaptive optimization behavior. The IMSS is evaluated on CEC 2005 and CEC 2013 test suites, and its results are compared with results produced by several state-of-the-art algorithms. For further validation, the presented approach is also applied on two well-studied engineering design problems. The obtained results indicate that the IMSS provides very competitive results compared to other algorithms on the aforementioned optimization problems.

Prognostic role of microRNA-150 in various carcinomas: a meta-analysis.

ObjectiveMicroRNA-150 (miR-150) was revealed to be an attractive prognostic biomarker in recent studies. However, the prognostic significance of miR-150 expression in cancer remains inconclusive. The aim of this study was to summarize the global predicting role of miR-150 in survival in patients with various carcinomas.MethodsEligible studies were identified through multiple search strategies. Data were extracted from the studies by investigating the relationship between miR-150 expression and survival in patients with cancer. A meta-analysis of the hazard ratio (HR) was then performed to evaluate the prognostic role of miR-150 in different tumors. Pooled HRs of miR-150 for overall survival and progression-free survival were calculated to measure the effect of miR-150 expression on prognosis.ResultsThis meta-analysis included nine published studies concerning various carcinomas. Our results indicate that an elevated miR-150 expression is associated with an enhanced overall survival in the digestive tract cancer subgroup (HR =0.57, 95% confidence interval [CI]: 0.37–0.90) and a poor progression-free survival in various cancers (HR =3.08, 95% CI: 2.00–4.75).ConclusionmiR-150 may have the potential to become a new useful prognostic factor to monitor cancer prognosis and progression. However, given the current insufficient relevant data, further clinical studies are needed.

Circulating miRNAs as novel potential biomarkers for esophageal squamous cell carcinoma diagnosis: a meta-analysis update.

Early detection of esophageal squamous cell carcinoma (ESCC) is urgently needed to reduce the high morbidity and mortality of disease. Circulating microRNAs (miRNAs) are promising molecular biomarkers for ESCC prediction. We performed a comprehensive meta-analysis to systematically evaluate the diagnostic accuracy of circulating miRNAs in diagnosis of ESCC patients. Eligible studies were identified and assessed for quality employing multiple search strategies. Summary estimates for sensitivity, specificity, and other measures of accuracy of miRNAs in the diagnosis of ESCC were pooled using the bivariate random effects model. A total of 27 studies from 11 published articles were included in the meta-analysis. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of circulating miRNAs for the diagnosis of ESCC were 79.9% (95% confidence intervals [CI]: 76.2%-83.1%), 81.3% (95% CI: 75.7-85.9), 4.27 (95%CI: 3.27-5.58), 0.25 (95% CI: 0.21-0.29), and 17.29 (95% CI: 12.01-24.86), respectively. The area under the summary receiver operating characteristic curve was 0.87 (95% CI: 0.84-0.90). The subgroup analyses based on research country (China vs. Japan), specimen type (plasma vs. serum), miRNAs profiling (single vs. multiple), and test method (screening vs. candidate; Taqman vs. SYBR) indicated no significant difference in the diagnostic accuracy of each subgroup. Collectively, our findings indicate that circulating miRNAs have significant potential to be used as noninvasive biomarkers for early detection of ESCC. Moreover, the subgroup analyses demonstrated the feasibility of using blood miRNAs as an ESCC diagnostic biomarker in Japanese and Chinese populations. Further, both plasma and serum are recommended as clinical specimens for miRNA detection. Further studies will be needed to validate these findings using larger numbers of patients.

Examining exercise intention and behaviour during pregnancy using the Theory of Planned Behaviour: a meta-analysis

Background: The efficacy and predictive utility of the Theory of Planned Behaviour (TPB) in explaining a variety of behaviours including physical activity (PA) is well documented. However, the relative contribution of the theory’s components in describing intention and behaviour may differ depending on the context, time and population being studied. Such evidence is necessary to inform PA advice and interventions aimed at special populations including pregnant women. Objective: The purpose of this study was to review the existing literature surrounding the application of the TPB in explaining exercise intentions and behaviour during pregnancy and to evaluate the magnitude of relationships between TPB constructs within this context. Method: Multiple search strategies yielded 99 potentially relevant studies of which 47 were assessed against the inclusion criteria. Finally, eight studies were subjected to a random-effects meta-analysis. Result: Results confirmed the existence of a strong relationship between intention and behaviour while perceived behavioural control (PBC) revealed a weaker correlation with behaviour. Women’s attitude towards exercise had the strongest association with their intention to be physically active while expecting. However, both PBC and subjective norm showed strong relationships with intention. Conclusion: The study supports the TPB as a relevant conceptual framework for the investigation of PA intentions and behaviours during pregnancy. Furthermore, this study supported subjective norm as a pertinent construct to investigate exercise intentions and behaviour in a pregnant population. These findings present both researchers and practitioners with an opportunity for intervention and further research.

Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis.

BackgroundThe evidence from epidemiological studies concerning the relationship between serum vitamin D concentrations and rheumatoid arthritis (RA) is inconsistent. This meta-analysis is aimed at determining the magnitude of the correlation between this common autoimmune disease and vitamin D, an important nutrient known to dampen adaptive immune responses.MethodsThrough multiple search strategies, relevant literature was identified and evaluated for quality before May 16 2015. Data extracted from eligible studies was synthesized to calculate pooled correlation coefficient (r), mean difference (MD) and odds ratio (OR). The Venice criteria were applied to assess the credibility of the evidence for each statistically significant association.ResultsA total of 24 reports involving 3489 patients were selected for analysis. RA patients had lower vitamin D levels than healthy controls (MD:-16.52 nmol/L, 95% confidence intervals [CI]:-18.85 to -14.19 nmol/L). There existed a negative relationship between serum 25-hydroxyvitamin D (25OHD) level and disease activity index, e.g. 25OHD vs. Disease Activity Score in 28 joints (DAS28): r = -0.13, 95% CI -0.16 to -0.09; 25OHD vs. C-reactive protein: r = -0.12, 95% CI -0.23 to -0.00. Additionally, latitude-stratified subgroup analysis yielded a relatively stronger negative correlation between 25OHD and DAS28 in low-latitude areas. This inverse relationship also appeared more significant in developing countries than in developed countries. No publication bias was detected.ConclusionRA patients had lower vitamin D values than healthy controls. There was a negative association between serum vitamin D and RA disease activity. However, more strictly controlled studies are needed to validate these findings.

Prognostic Significance of MiRNA in Patients with Diffuse Large B-Cell Lymphoma: a Meta-Analysis

Introduction: This pooled analysis study aimed to reveal the prognostic relevance of microRNAs (miRNAs) in patients with diffuse large B-cell lymphoma (DLBCL). Materials and Methods: We examined the impact of miRNAs on clinical outcome. Eligible studies were identified and quality assessed using multiple search strategies. Data were extracted from included studies which correlated survival with expression of miRNAs (serum or tissue). Results: We pooled proper studies, and combined the hazard ratios with 95% confidence intervals to estimate strength of the correlations. There were 18 studies including 1950 patients with DLBCL eligible for pooled analysis. We found significant combined HRs for poor overall survival for high expression of miR-21 and low expression of miR-224 in tumor tissue, but for favorable relapse free survival for high expression of miR-21 in serum. Progression free survival was shortened in patients with low expression of miR-199a/b, miR-146b-5p, miR-224 and high expression of miR-222. Conclusion: MiRNAs may act as independent prognostic factors in patients with DLBCL, and useful in risk stratification.

Multiobjective Local Search Algorithm-Based Decomposition for Multiobjective Permutation Flow Shop Scheduling Problem

This paper focuses on the multiobjective solutions of the flow shop scheduling problem with and without sequence dependent setup times. In our case, the two objectives are the minimization of makespan and total flowtime. These problems are solved with a novel multiobjective local search framework-based decomposition, called multiobjective local search based decomposition (MOLSD), which decomposes a multiobjective problem into a number of single objective optimization subproblems using aggregation method and optimizes them simultaneously. First, a problem-specific Nawaz–Enscore–Hoam heuristic is used to initialize the population to enhance the quality of the initial solution. Second, a Pareto local search embedded with a heavy perturbation operator is applied to search the promising neighbors of each nondominated solution found so far. Then, when solving each subproblem, a single insert-based local search, a multiple local search strategy, and a doubling perturbation mechanism are designed to exploit the new individual. Finally, a restarted method is used to avoid the algorithm trapping into the local optima, which has a significant effect on the performance of the MOLSD. Comprehensive experiments have been conducted by two standard multiobjective metrics: 1) hyper-volume indicator; and 2) set coverage. The experimental results show that the proposed MOLSD provides better solutions that several state of the art algorithms.

Consumer Information and Treatment Resources for Posttraumatic Stress Disorder

In the context of multiple treatment options for posttraumatic stress disorder (PTSD) and a large, growing need for consumer information regarding accessible and effective treatments, this article identifies and reviews available information and treatment resources. Multiple search strategies identified a suite of information sources, including meta-analyses and systematic reviews of PTSD treatments, the program evaluation and implementation literature, the economics literature, Internet sites, and other resources for veteran and civilian consumers. Resources were evaluated with regard to their target audiences, depth and breadth of treatment options covered, nature of the information provided, and accessibility to consumers. A large body of research covers the various treatments and sets of treatment guidelines for PTSD. Despite the extensive scientific information targeted at providers and researchers, the quality, accessibility, and usability of the published research varies widely. The Veterans Health Administration provides the most extensive information on various treatment options and where to obtain treatment within that system. Publicly available websites provide information on multiple treatment options, but information to help nonveterans navigate treatment choices is limited. Published reports of PTSD program-evaluation and implementation studies are sparse. Information on PTSD treatment options available to consumers can be overwhelming and confusing, which places an unnecessary burden on an already vulnerable group of patients and their families. Exacerbating the situation is the shortage of program-evaluation and implementation research. The dearth of centralized and accessible information related to nonveteran PTSD patient groups needs to be addressed.

Clinical judgement within the South African clinical nursing environment: A concept analysis

Reform in the South African healthcare and educational system were characterized by the ideals that the country needs to produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses.The objective of this study was to explore and describe clinical judgement through various data sources and review of literature to clarify the meaning and promote a common understanding through formulating the characteristics and developing a connotative (theoretical) definition of the concept.An explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search strategies were used, for the time frame 1982–2013. A concept analysis was used to arrive at a theoretical definition of the concept of ‘clinical judgement’ as a complex cognitive skill to evaluate patient needs, adaption of current treatment protocols as well as new treatment strategies, prevention of adverse side effects through being proactive rather than reactive within the clinical nursing environment.The findings emphasized clinical judgement as skill within the clinical nursing environment, thereby improving autonomous and accountable nursing care. These findings will assist nurse leaders and clinical nurse educators in developing a teaching-learning strategy to promote clinical judgement in undergraduate nursing students, thereby contributing to the quality of nursing care.

Artificial bee colony algorithm with multiple search strategies

Considering that the solution search equation of artificial bee colony (ABC) algorithm does well in exploration but badly in exploitation which results in slow convergence, this paper studies whether the performance of ABC can be improved by combining different search strategies, which have distinct advantages. Based on this consideration, we develop a novel ABC with multiple search strategies, named MuABC. MuABC uses three search strategies to constitute a strategy candidate pool. In order to further improve the performance of the algorithm, an adaptive selection mechanism is used to choose suitable search strategies to generate candidate solutions based on the previous search experience. In addition, a candidate solution is generated based on a Gaussian distribution to exploit the search ability. MuABC is tested on a set of 22 benchmark functions, and is compared with some other ABCs and several state-of-the-art algorithms. The comparison results show that the proposed algorithm offers the highest solution quality, the fastest global convergence, and the strongest robustness among all the contenders on almost all the cases.

Project Management of Randomized Clinical Trials: A Narrative Review.

Context:A well-structured protocol for a clinical trial may be able to answer clinical questions, but it cannot be deemed enough to ensure success in the face of incompetent management of time as well as human and economic resources. To address this problem, in this article, we present our literature review on evidence as to how a good knowledge of proper management among researchers can enhance the likelihood of the success of clinical trial projects.Evidence Acquisition:Using multiple search strategies, we conducted a literature review on published studies in the English language from 2002 to 2012 by searching the Cochrane Database of Systematic Reviews, MEDLINE, Google Scholar, and EMBASE.Results:Our review suggests that a successful trial requires a work plan or work scope as well as a timeline. The trial manager should subsequently manage the study in accordance with the plan and the timeline. Many research units have called for a clinical project manager with scientific background and regulatory skills to effect coordination among various aspects of a clinical trial.Conclusions:Project management may benefit both the managerial and scientific aspects of medical projects and reduce fund waste. However, little has been written to date on project management in the context of clinical research. The suggestions represent the views of the individual authors. To provide a high level of evidence in this regard, we recommend that a randomized controlled trial be performed to compare trial projects progressed with and without the use of project management.

Early Postoperative Complications following Gracilis Free Muscle Transfer for Facial Reanimation: A Systematic Review and Pooled Data Analysis.

Multiple studies have detailed promising smile restoration following gracilis free muscle transfer for facial reanimation but information detailing the potential complications is lacking. The aim of this study is to systematically review the literature to evaluate the reported complication rate associated with this procedure. We also aim to determine the most common occurring complications. The PubMed, Embase, and Web of Science databases were queried with multiple search strategies for published articles between January 1950 and February 2013 that detailed gracilis free muscle transfer for facial reanimation. Title, abstract, and full text review was performed. Complications were defined as any reported, identifiable adverse outcome that required an alteration in treatment for correction. The literature search yielded 62 studies of gracilis free muscle transfer for facial reanimation. Overall, 36 articles (58%) reported whether or not a complication had occurred. The overall complication rate based on pooled proportions was 9.6% and the most commonly occurring complications were postoperative hematoma (3.6%) and infection (3.5%). Our data suggests that complications after gracilis free muscle transfer for facial reanimation may be underreported and this complex procedure may in fact be associated with significant adverse outcomes as high as 9.6%.

Prognostic role of microRNA-145 in prostate cancer: A systems review and meta-analysis.

BackgroundMany studies have shown that microRNAs (miRNAs) exhibit altered expression in various cancers and may play an important role as prognostic biomarkers. The present meta-analysis was undertaken to summarize recent studies of the use of microRNA-145 (miR-145) in the assessment of prostate cancer and to analyze the prognostic role of miR-145 for disease-free survival (DFS) outcome.MethodsThe present meta-analysis was performed by searching PubMed with the use of multiple search strategies. Data were extracted from studies examining DFS in patients with prostate cancer who showed lower expression of miR-145. Pooled hazard ratios of miR-145 and 95% confidence intervals were calculated. Four studies with a total of 211 patients were included in this meta-analysis.ResultsFor overall DFS, the pooled hazard ratio of lower miR-145 expression in prostate cancer was 0.74 (95% confidence interval: 0.23–2.34, P = 0.001). Thus, lower miR-145 expression was found to significantly predict poorer outcomes.ConclusionsThe present findings suggest that downregulation of the expression of miR-145 might predict poor prognosis in patients with prostate cancer.

A novel multi-objective particle swarm optimization with multiple search strategies

Recently, multi-objective particle swarm optimization (MOPSO) has shown the effectiveness in solving multi-objective optimization problems (MOPs). However, most MOPSO algorithms only adopt a single search strategy to update the velocity of each particle, which may cause some difficulties when tackling complex MOPs. This paper proposes a novel MOPSO algorithm using multiple search strategies (MMOPSO), where decomposition approach is exploited for transforming MOPs into a set of aggregation problems and then each particle is assigned accordingly to optimize each aggregation problem. Two search strategies are designed to update the velocity of each particle, which is respectively beneficial for the acceleration of convergence speed and the keeping of population diversity. After that, all the non-dominated solutions visited by the particles are preserved in an external archive, where evolutionary search strategy is further performed to exchange useful information among them. These multiple search strategies enable MMOPSO to handle various kinds of MOPs very well. When compared with some MOPSO algorithms and two state-of-the-art evolutionary algorithms, simulation results show that MMOPSO performs better on most of test problems.

Prognostic role of hormone receptors in endometrial cancer: a systematic review and meta-analysis.

BackgroundThe aim of this study was to summarize the global predicting role of hormone receptors for survival in endometrial cancer.MethodsEligible studies were identified and assessed for quality through multiple search strategies. Data were collected from studies comparing overall survival (OS), cancer-specific survival (CSS), or progression-free survival (PFS) in patients with elevated levels of estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) with those in patients with lower levels. The combined hazard ratios of ER, PR, and HER2 for survival were calculated.ResultsA total of 98 studies were included for meta-analysis (44 for ER, 38 for PR, and 16 for HER2). Higher levels of either ER or PR could significantly indicate better survival. The pooled hazard ratios (HRs) of ER for OS, CSS, and PFS were 0.75 (95 % CI, 0.68–0.83), 0.45 (95 % CI, 0.33–0.62), and 0.66 (95 % CI, 0.52–0.85), respectively. The combined HRs of PR for OS, CSS, and PFS reached 0.63 (95 % CI, 0.56–0.71), 0.62 (95 % CI, 0.42–0.93), and 0.45 (95 % CI, 0.30–0.68), respectively. In contrast, elevated levels of HER2 could predict worse outcome with a HR of 1.98 (95 % CI, 1.49–2.62) for OS, and a HR of 2.26 (95 % CI, 1.57–3.25) for PFS.ConclusionsIn patients with endometrial cancer, higher level of ER and PR predicted favorable survival, and increased level of HER2 was associated with poorer survival. All of the three hormone receptors had prognostic value for survival.

OPINION]Investigator Selection for Multicenter Clinical Trials

The selection of investigators is one of the first major activities in the conduct of multicenter clinical trials. Based on the requirements of the clinical trial protocol, sponsors may use multiple search strategies such as querying public, private, and/or internal and databases, securing referrals

Prognostic value of programed death ligand 1 in patients with solid tumors: A meta-analysis

A great deal of research have been performed to explore the prognostic value of programed death ligand 1 (PD-L1) in solid tumors in last decades. However, the results still remain inconsistent. To clarify a precise determinant of the clinical significance of PD-L1, we conducted a meta-analysis to evaluate the overall risk of PD-L1 on survival for patients with solid tumors. Related studies were identified through multiple search strategies from PubMed, Embase, and Cochrane databases. Data were collected from studies comparing overall survival (OS) in patients with positive PD-L1 and those having a negative expression. The meta-analysis was performed by Stata version 11.0 (Stata Corporation, College Station, TX, USA). The pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. A total of 14 eligible studies involved 2916 patients were included in our meta-analysis. A summary HRs of all studies and subgroup HRs were calculated. The combined HRs suggested that a positive PD-L1 expression had an unfavorable impact on OS (1.67, 95% CI 1.30-2.16; P < 0.001). Similar results were also observed in subgroup analysis, according to tumor types, regions, patients' number, and publication year. With the available evidence, PD-L1 might serve as an efficient prognostic indicator in solid tumor and may represent the important new therapeutic target. More prospective studies are now needed to confirm the clinical utility of PD-L1 as an independent prognostic marker.