HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Artyom Sedrakyan Tom Treasure Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sedrakyan, A. Articles by Treasure, T. Search for Related Content PubMed PubMed Citation Articles by Sedrakyan, A. Articles by Treasure, T. Related Collections Lung - cancer

J Thorac Cardiovasc Surg 2004;128:414-419
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

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

^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.

This article has been cited by other articles:

				J.-P. Pignon, H. Tribodet, G. V. Scagliotti, J.-Y. Douillard, F. A. Shepherd, R. J. Stephens, A. Dunant, V. Torri, R. Rosell, L. Seymour, et al. Lung Adjuvant Cisplatin Evaluation: A Pooled Analysis by the LACE Collaborative Group J. Clin. Oncol., July 20, 2008; 26(21): 3552 - 3559. [Abstract] [Full Text] [PDF]

				K. M.W. Pisters, W. K. Evans, C. G. Azzoli, M. G. Kris, C. A. Smith, C. E. Desch, M. R. Somerfield, M. C. Brouwers, G. Darling, P. M. Ellis, et al. Cancer Care Ontario and American Society of Clinical Oncology Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non Small-Cell Lung Cancer Guideline J. Clin. Oncol., December 1, 2007; 25(34): 5506 - 5518. [Abstract] [Full Text] [PDF]

				B. A. Whitson, S. S. Groth, and M. A. Maddaus Surgical Assessment and Intraoperative Management of Mediastinal Lymph Nodes in Non-Small Cell Lung Cancer Ann. Thorac. Surg., September 1, 2007; 84(3): 1059 - 1065. [Abstract] [Full Text] [PDF]

				T. Treasure The evidence on which to base practice: different tools for different times Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 819 - 824. [Full Text] [PDF]

				D. West, A. J.B. Kirk, and J. Dunning Chemotherapy following complete resection of non-small-cell lung cancer is of small but significant benefit in terms of survival Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 488 - 492. [Abstract] [Full Text] [PDF]

				J-E C Holty and M K Gould When in doubt should we cut it out? The role of surgery in non-small cell lung cancer. Thorax, July 1, 2006; 61(7): 554 - 556. [Full Text] [PDF]

				N. Alam, G. Darling, F. A. Shepherd, J. A. Mackay, W. K. Evans, and Lung Cancer Disease Site Group of Cancer Care Onta Postoperative Chemotherapy in Nonsmall Cell Lung Cancer: A Systematic Review. Ann. Thorac. Surg., May 1, 2006; 81(5): 1926 - 1936. [Abstract] [Full Text] [PDF]

				A. Auperin, C. Le Pechoux, J. P. Pignon, C. Koning, B. Jeremic, G. Clamon, L. Einhorn, D. Ball, M. G. Trovo, H. J. M. Groen, et al. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): A meta-analysis of individual data from 1764 patients Ann. Onc., March 1, 2006; 17(3): 473 - 483. [Abstract] [Full Text] [PDF]

				A. L. Visbal, N. B. Leighl, R. Feld, and F. A. Shepherd Adjuvant Chemotherapy for Early-Stage Non-small Cell Lung Cancer Chest, October 1, 2005; 128(4): 2933 - 2943. [Abstract] [Full Text] [PDF]

				K. M.W. Pisters and T. Le Chevalier Adjuvant Chemotherapy in Completely Resected Non-Small-Cell Lung Cancer J. Clin. Oncol., May 10, 2005; 23(14): 3270 - 3278. [Abstract] [Full Text] [PDF]

				S. Burdett, L. Stewart, and J.-P. Pignon Chemotherapy in non-small cell lung cancer: An update of an individual patient data-based meta-analysis J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1205 - 1205. [Full Text] [PDF]

				A. Sedrakyan and K. O'Byrne Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1205 - 1206. [Full Text] [PDF]