Postoperative chemotherapy for non-small cell lung cancer: A systematic review and meta-analysis.
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.
Sedrakyan
Artyom
A
Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. asedrakyan@rcseng.ac.uk
Van Der Meulen
Jan
J
O'Byrne
Ken
K
Prendiville
Joseph
J
Hill
Jennifer
J
Treasure
Tom
T
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D005641:Tegafur / Q000627:therapeutic use
D000970:Antineoplastic Agents; D005641:Tegafur; D002945:Cisplatin