Postoperative chemotherapy for non-small cell lung cancer : a systematic review and meta-analysis

Sedrakyan, A., Van Der Meulen, J., O'Byrne, Kenneth J., Prendiville, J., Hill, J., & Treasure, T. (2004) Postoperative chemotherapy for non-small cell lung cancer : a systematic review and meta-analysis. Journal of Thoracic and Cardiovascular Surgery, 128(3), pp. 414-419.

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Background Postoperative chemotherapy is currently not recommended for resected non-small cell lung cancer in many countries and centers. Recently, results of several large randomized clinical trials were reported with conflicting evidence. Accordingly, we sought to determine whether postoperative chemotherapy is associated with improved survival compared with that after surgical intervention alone.

Methods Randomized clinical trials with cisplatin- or uracil plus ftorafur-containing regimens were included and evaluated separately. A systematic review that included randomized clinical trials performed before 1995 was identified and found to be of adequate quality. Further randomized controlled trials were identified by searching MEDLINE, EMBASE, and the Cochrane Controlled Trials Register from 1995 through 2004. In addition, the reference lists of articles and conference abstracts were searched. The logarithm of the hazard ratio and its standard error were calculated, and a fixed-effect model was used to combine the estimates. Results There were 7200 patients enrolled in 19 trials included in the analyses. An overall estimate of 13% relative reduction in mortality (95% confidence interval, 7%-19%) was found. There was 11% relative reduction in mortality associated with postoperative cisplatin (95% confidence interval, 4%-18%; P = .004) and 17% associated with uracil plus ftorafur (95% confidence interval, 5%-27%; P = .006) compared with that after surgical intervention alone. This means that there would be an additional survivor at 5 years for 25 patients treated with cisplatin or for 30 patients treated with uracil plus ftorafur.

Conclusions Postoperative chemotherapy is associated with improved survival compared with that after surgical intervention alone. Selected patients with completely resected non-small cell lung cancer should be offered chemotherapy. Copyright © 2004 by The American Association for Thoracic Surgery.

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ID Code: 65678
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: 10, cisplatin, UFT, cancer chemotherapy, cancer survival, clinical trial, Cochrane Library, confidence interval, EMBASE, human, lung non small cell cancer, MEDLINE, meta analysis, mortality, postoperative care, priority journal, review, surgical technique, systematic review, time series analysis, Antineoplastic Agents, Carcinoma, Non-Small-Cell Lung, Combined Modality Therapy, Humans, Lung Neoplasms, Randomized Controlled Trials, Survival Rate, Tegafur
DOI: 10.1016/j.jtcvs.2004.04.027
ISSN: 0022-5223
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2004 Mosby, Inc.
Deposited On: 06 Jan 2014 04:06
Last Modified: 08 Jan 2014 05:45

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