Because most cancer outcomes are somewhat uncommon, small randomized controlled trials (RCTs) evaluating sirolimus-based immunosuppressant regimens have not been able to assess cancer associations.
This is one of the main differences between our study and most other studies, including a recently published small randomized trial conducted in China [ 13].
However, the clinical significance of the expression of these genes remains unclear, as many inconsistent results are reported in the literature, and most published reports concern retrospective analyses of data from nonrandomized or relatively small randomized studies.
After publication of the Dutch guidelines two small randomized studies reported that preterm infants need additional oxygen in most cases [ 12, 40].
Fifty-five studies were identified; most were single-center (93%) and retrospective (64%), with only a few, small randomized studies (eight studies, 14.5%).
Even though only 3 small randomized trials were included in this study, they suggested gemcitabine combined with cisplatin or oxaliplatin as the most active, and therefore they were considered as the provisional standard regimens in aBTC [ 8].
A spate of small randomized trials confirmed the effect.
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