Intervention Review

Chemotherapy and surgery versus surgery alone in non-small cell lung cancer

  1. Sarah Burdett1,*,
  2. Lesley Stewart2,
  3. Larysa Rydzewska1

Editorial Group: Cochrane Lung Cancer Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 8 APR 2007

DOI: 10.1002/14651858.CD006157.pub2

Database Title

Additional Information

How to Cite

Burdett S, Stewart L, Rydzewska L. Chemotherapy and surgery versus surgery alone in non-small cell lung cancer. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006157. DOI: 10.1002/14651858.CD006157.pub2.

Author Information

  1. 1

    MRC Clinical Trials Unit, Meta-analysis Group, London, UK

  2. 2

    University of York, Centre for Reviews and Dissemination, York, UK

*Sarah Burdett, Meta-analysis Group, MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK. sb@ctu.mrc.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The role of pre-operative chemotherapy in the treatment of patients with non-small cell lung cancer (NSCLC) was not clear. A systematic review and quantitative meta-analysis were therefore undertaken to evaluate the available evidence from randomised trials.

Objectives

To evaluate the effect of pre-operative chemotherapy on survival in patients with non-small cell lung cancer. If adequate data are available, to investigate whether or not pre-defined patient subgroups benefit more or less from pre-operative chemotherapy.

Search methods

MEDLINE and CANCERLIT searches for randomised controlled trials (RCTs) were supplemented by information from trial registers and by handsearching relevant meeting proceedings and by discussion with relevant trialists and organisations.

Selection criteria

RCTs were eligible for inclusion provided the patients had been randomised between chemotherapy followed by surgery versus surgery alone and that the method of randomisation precluded prior knowledge of the treatment to be assigned.

Data collection and analysis

A systematic review and meta-analysis based on aggregate data extracted from trial publications was carried out to assess the effectiveness of pre-operative chemotherapy in NSCLC. This involved identifying eligible RCTs and extracting aggregate data from the abstracts or reports of these RCTs. Hazard ratios were calculated from published summary statistics and then combined to give pooled estimates of treatment efficacy.

Main results

Twelve eligible RCTs were identified. Data were available from seven RCTs including 988 patients (75% of eligible patients). Pre-operative chemotherapy increased survival with a hazard ratio of 0.82 (95%CI 0.69-0.97) P = 0.022. This is equivalent to an absolute benefit of 6%, increasing overall survival across all stages of disease from 14% to 20% at 5 years. There was no evidence of statistical heterogeneity (P = 0.980, I2 = 0).

Authors' conclusions

This analysis shows a significant increase in survival attributable to pre-operative chemotherapy. This is currently the best estimate of the effectiveness of this therapy, but is based on a small number of trials and patients. This analysis was unable to address important questions such as whether particular types of patients may benefit more or less from pre-operative chemotherapy or whether the early stopping of a number of included RCTs impacted on the results. These issues may be addressed by an ongoing individual patient data (IPD) meta-analysis.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

The pre-operative chemotherapy might increase survival in patients with non-small cell lung cancer when compared to surgery alone

The results of this systematic review suggest that pre-operative chemotherapy might increase survival in patients with non-small cell lung cancer when compared to surgery alone. However, an individual patient data systematic review and meta-analysis is needed to give us a more reliable assessment of the size of benefits and to explore whether pre-operative chemotherapy may be more or less effective for particular types of patients.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

感染人類免疫缺乏病毒的病人在第一線抗反轉錄病毒治療失敗後的抗病毒處方

高活性抗反轉錄病毒療法，已減少感染人類免疫缺乏病毒/後天免疫不全症候群病人的併發症及死亡率。常見的第一線抗反轉錄病毒療法處方包括一個非核甘反轉錄脢抑製劑(NNRTI)和兩個核甘反轉錄脢抑製劑(NRTIs) 。如果治療失敗，換成第二線治療是必要的。

目標

這統合分析旨在評估在第一線高活性抗反轉錄病毒處方治療失敗後的感染人類免疫缺乏病毒病人，何為最理想的抗反轉錄病毒處方。這些第一線處方包括d4T+3TC+NVP; d4T+3TC+EFV; ZDV+3TC+NVP;和ZDV+3TC+EFV。

搜尋策略

不限定語言，以相關的搜索字詞查閱電子資料庫和研討會論文。

選擇標準

這篇文章包含的隨機對照試驗，主要是關於人類免疫缺乏病毒感染的成人患者在接受第一線抗反轉錄病毒治療後病毒學上的失敗後，接受第二線抗反轉錄病毒治療的治療。主要結果的評估，包括達成血漿中無法偵測到人類免疫缺乏病毒RNA濃度(病毒量)患者的比例。次要的結果評估，包括CD4細胞計數平均值的改變，臨床症狀的改善，臨床症狀的改善，副作用的比率，治療失敗的比率，因治療毒性而改變治療的比率和死亡率。

資料收集與分析

2位作者評估每篇參考文獻，根據先前建立的優先順序準則來決定引用或排除。利用一個標準化的抽取模式獨立抽取數據。

主要結論

共找到21篇紀錄，其中6篇重複。沒有一個記錄達到納入的標準。

作者結論

對第一線治療失敗的感染人類免疫缺乏病毒患者，第一線的處方包括d4T+3TC+NVP; d4T+3TC+EFV; ZDV+3TC+NVP; 和ZDV+3TC+EFV，沒有足夠的證據來評估第二線療法的成效。目前的建議是根據現有的資源和從個別化的治療得來的結果，這些個別化的治療是根據抗藥性測試及臨床的判斷選擇

翻譯人

本摘要由臺北榮民總醫院陳三奇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

高活性抗反轉錄病毒療法已明顯降低全球感染人類免疫缺乏病毒患者的發病率和死亡率。第一線的抗反轉錄病毒療法治療有很多選擇，但第二線治療對第一線治療失敗的人是必要的。這回顧性文章試圖評估需要第二線治療的愛滋病毒感染者的最佳抗反轉錄病毒療法；不過，這篇回顧性文章並沒有這個主題的隨機對照試驗。雖然這種試驗基於各種原因而難以進行，第二線療法的隨機對照試驗對於治療的是必須的，尤其是在無法獲得病毒基因型和無法密切監測愛滋病毒的病毒量的情形下。

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