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The searches resulted in 337 journal articles. We used Covidence (covidence.org) to initially screen articles based on the title and abstract. To qualify as a systematic review, studies had to summarize evidence across multiple studies and provide information on the search strategy, such as search terms, databases, or inclusion/exclusion criteria. Meta-analyses were classified as quantitative syntheses of results across multiple studies (Onishi 2014). Two screeners independently reviewed the titles and abstracts of each citation and made a decision regarding its appropriateness for inclusion. Next, screeners held a meeting to revisit the citations in conflict and arrive at a final consensus. Following the screening process, full-text versions of included articles were obtained via EndNote.   1.3 Coding Abstracts  To ensure accurate coding and clear directions, the accuracy of the  coding keys were process, an abstraction manual was  developedfor each study  and pilot-tested on a handful of articles. piloted prior to training coders.  A training session was conducted to familiarize coders with the process, and a subset subsets  of studies from the screening process were jointly coded as a group. After training, each coder was given 3 three  new articles to code independently. These data were analyzed for inter-rater agreement by calculating the Kappa statistic. Cohen's kappa.  As inter-rater agreement was acceptable (k=0.65; agreement=75 percent),each percent), each  coder was assigned an equal number of articles to code. for data abstraction.  After the initial coding process, validation checks were conducted such that each coded element was verified by a second coder. After these checks were performed, Following this process,  coders met to discuss disagreements and settle them by consensus.Articles were excluded if they were genetic studies (n=40), individual patient data (n=20), not a meta-analysis or systematic review (n=9), genomic study (n=3), the article could not be retrieved (n=2), a letter to the editor (n=1), or a histological study (n=1).  The remaining 182 articles were included in an analysis of the final data using STATA 13.1.