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Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data

A Auperin, T Le Chevalier, C Le Pechoux, JP Pignon, H Tribodet, S Burdett, LA Stewart, JF Tierney, RJ Stephens, R Arriagada, et al. (2010) LANCET. 375(9722). p.1267-1277
abstract
Background Many randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy. Methods We included randomised trials, not confounded by additional therapeutic differences between the two groups and that started randomisation on or after Jan 1,1965, which compared surgery plus adjuvant chemotherapy versus surgery alone, or surgery plus adjuvant radiotherapy and chemotherapy versus surgery plus adjuvant radiotherapy. Updated individual patient data were collected, checked, and included in meta-analyses stratified by trial. The primary endpoint was overall survival, defined as time from randomisation until death by any cause. All analyses were by intention to treat. Findings The first meta-analysis of surgery plus chemotherapy versus surgery alone was based on 34 trial comparisons and 8447 patients (3323 deaths). We recorded a benefit of adding chemotherapy after surgery (hazard ratio [HR] 0.86, 95% CI 0.81-0.92, p<0.0001), with an absolute increase in survival of 4% (95% CI 3-6) at 5 years (from 60% to 64%). The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy was based on 13 trial comparisons and 2660 patients (1909 deaths). We recorded a benefit of adding chemotherapy to surgery plus radiotherapy (HR 0-88,95% CIl 0.81-0.97, p=0.009), representing an absolute improvement in survival of 4% (95% CI 1-8) at 5 years (from 29% to 33%). In both meta-analyses we noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup. Interpretation The addition of adjuvant chemotherapy after surgery for patients with operable non-small-cell lung cancer improves survival, irrespective of whether chemotherapy was adjuvant to surgery alone or adjuvant to surgery plus radiotherapy.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
JAPAN STUDY-GROUP, VINORELBINE PLUS CISPLATIN, URACIL-TEGAFUR, SURGERY, THERAPY, UFT, VINDESINE, SURVIVAL, RANDOMIZED CONTROLLED-TRIALS, RESECTED STAGE-I
journal title
LANCET
Lancet
volume
375
issue
9722
pages
11 pages
Web of Science type
Article
Web of Science id
000276858400029
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
33.633 (2010)
JCR rank
2/151 (2010)
JCR quartile
1 (2010)
ISSN
0140-6736
DOI
10.1016/S0140-6736(10)60059-1
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1186664
handle
http://hdl.handle.net/1854/LU-1186664
date created
2011-03-11 17:10:05
date last changed
2016-12-19 15:44:31
@article{1186664,
  abstract     = {Background Many randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy.
Methods We included randomised trials, not confounded by additional therapeutic differences between the two groups and that started randomisation on or after Jan 1,1965, which compared surgery plus adjuvant chemotherapy versus surgery alone, or surgery plus adjuvant radiotherapy and chemotherapy versus surgery plus adjuvant radiotherapy. Updated individual patient data were collected, checked, and included in meta-analyses stratified by trial. The primary endpoint was overall survival, defined as time from randomisation until death by any cause. All analyses were by intention to treat.
Findings The first meta-analysis of surgery plus chemotherapy versus surgery alone was based on 34 trial comparisons and 8447 patients (3323 deaths). We recorded a benefit of adding chemotherapy after surgery (hazard ratio [HR] 0.86, 95\% CI 0.81-0.92, p{\textlangle}0.0001), with an absolute increase in survival of 4\% (95\% CI 3-6) at 5 years (from 60\% to 64\%). The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy was based on 13 trial comparisons and 2660 patients (1909 deaths). We recorded a benefit of adding chemotherapy to surgery plus radiotherapy (HR 0-88,95\% CIl 0.81-0.97, p=0.009), representing an absolute improvement in survival of 4\% (95\% CI 1-8) at 5 years (from 29\% to 33\%). In both meta-analyses we noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup.
Interpretation The addition of adjuvant chemotherapy after surgery for patients with operable non-small-cell lung cancer improves survival, irrespective of whether chemotherapy was adjuvant to surgery alone or adjuvant to surgery plus radiotherapy.},
  author       = {Auperin, A and Le Chevalier, T and Le Pechoux, C and Pignon, JP and Tribodet, H and Burdett, S and Stewart, LA and Tierney, JF and Stephens, RJ and Arriagada, R and Higgins, JP and Johnson, DH and van Meerbeeck, J and Parmar, MKB and Souhami, RL and Bergman, B and Dautzenberg, B and Douillard, JY and Dunant, A and Endo, C and Girling, DJ and Imaizumi, M and Kato, H and Keller, SM and Kimura, H and Knuuttila, A and Kodama, K and Komaki, R and Kris, MG and Lad, T and Mineo, T and Park, JH and Piantadosi, S and Pyrhonen, S and Rosell, R and Scagliotti, GV and Seymour, LW and Shepherd, FA and Spiro, SG and Strauss, GM and Sylvester, R and Tada, H and Tanaka, F and Torri, V and Wada, H and Waller, D and Xu, GC},
  issn         = {0140-6736},
  journal      = {LANCET},
  keyword      = {JAPAN STUDY-GROUP,VINORELBINE PLUS CISPLATIN,URACIL-TEGAFUR,SURGERY,THERAPY,UFT,VINDESINE,SURVIVAL,RANDOMIZED CONTROLLED-TRIALS,RESECTED STAGE-I},
  language     = {eng},
  number       = {9722},
  pages        = {1267--1277},
  title        = {Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data},
  url          = {http://dx.doi.org/10.1016/S0140-6736(10)60059-1},
  volume       = {375},
  year         = {2010},
}

Chicago
Auperin, A, T Le Chevalier, C Le Pechoux, JP Pignon, H Tribodet, S Burdett, LA Stewart, et al. 2010. “Adjuvant Chemotherapy, with or Without Postoperative Radiotherapy, in Operable Non-small-cell Lung Cancer: Two Meta-analyses of Individual Patient Data.” Lancet 375 (9722): 1267–1277.
APA
Auperin, A., Le Chevalier, T., Le Pechoux, C., Pignon, J., Tribodet, H., Burdett, S., Stewart, L., et al. (2010). Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. LANCET, 375(9722), 1267–1277.
Vancouver
1.
Auperin A, Le Chevalier T, Le Pechoux C, Pignon J, Tribodet H, Burdett S, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. LANCET. 2010;375(9722):1267–77.
MLA
Auperin, A, T Le Chevalier, C Le Pechoux, et al. “Adjuvant Chemotherapy, with or Without Postoperative Radiotherapy, in Operable Non-small-cell Lung Cancer: Two Meta-analyses of Individual Patient Data.” LANCET 375.9722 (2010): 1267–1277. Print.