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J Thorac Cardiovasc Surg 2004;128:414-419
© 2004 The American Association for Thoracic Surgery
General thoracic surgery |
a Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
b Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
c Department of Oncology, St James's Hospital, Dublin, Ireland
d Guy's Hospital, London, United Kingdom
e National Collaborating Centre for Acute Care, Royal College of Surgeons of England, London, United Kingdom
Received for publication March 16, 2004; revisions received April 15, 2004; accepted for publication April 23, 2004.
* Address for reprints: Artyom Sedrakyan, MD, PhD, Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
asedrakyan{at}rcseng.ac.uk
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.
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