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

被引：520

作者：

Auperin, A. ^{[2
]}

Le Chevalier, T. ^{[2
]}

Le Pechoux, C. ^{[2
]}

Pignon, J. P. ^{[2
]}

Tribodet, H. ^{[2
]}

Burdett, S. ^{[1
]}

Stewart, L. A.

Tierney, J. F.

Stephens, R. J.

Arriagada, R. ^{[2
,3
]}

Higgins, J. P. ^{[6
]}

Johnson, D. H. ^{[4
]}

van Meerbeeck, J. ^{[5
]}

Parmar, M. K. B.

Souhami, R. L. ^{[7
]}

Bergman, B. ^{[8
]}

Dautzenberg, B. ^{[9
]}

Douillard, J. Y.

Dunant, A. ^{[2
]}

Endo, C. ^{[10
]}

Girling, D. J.

Imaizumi, M. ^{[11
]}

Kato, H. ^{[12
]}

Keller, S. M. ^{[13
]}

Kimura, H. ^{[14
]}

Knuuttila, A. ^{[15
]}

Kodama, K. ^{[16
]}

Komaki, R. ^{[17
]}

Kris, M. G. ^{[18
]}

Lad, T. ^{[19
]}

Mineo, T. ^{[20
]}

Park, J. H. ^{[21
]}

Piantadosi, S. ^{[22
]}

Pyrhonen, S. ^{[23
]}

Rosell, R. ^{[24
]}

Scagliotti, G. V. ^{[25
]}

Seymour, L. W. ^{[26
]}

Shepherd, F. A. ^{[27
]}

Spiro, S. G. ^{[28
]}

Strauss, G. M. ^{[29
]}

Sylvester, R. ^{[30
]}

Tada, H. ^{[31
]}

Tanaka, F. ^{[32
]}

Torri, V. ^{[33
]}

Wada, H. ^{[34
]}

Waller, D. ^{[35
]}

Xu, G. C. ^{[36
]}

机构：

[1] MRC, Clin Trials Unit, Meta Anal Grp, London NW1 2DA, England

[2] Inst Gustave Roussy, Villejuif, France

[3] Karolinska Inst, Stockholm, Sweden

[4] Vanderbilt Ingram Canc Ctr, Nashville, TN USA

[5] Ghent Univ Hosp, B-9000 Ghent, Belgium

[6] MRC, Biostat Unit, Cambridge CB2 2BW, England

[7] Canc Res UK, London, England

[8] Sahlgrens Acad, Gothenburg, Sweden

[9] Grp Hosp Pitie Salpetriere, F-75634 Paris, France

[10] Tohoku Univ, Inst Dev Aging & Canc, Sendai, Miyagi 980, Japan

[11] Nagoya Univ, Sch Med, Nagoya, Aichi 466, Japan

[12] Tokyo Med Univ, Tokyo, Japan

[13] Montefiore Med Ctr, Bronx, NY USA

[14] Chiba Canc Ctr, Chiba 2608717, Japan

[15] Univ Helsinki, Cent Hosp, Helsinki, Finland

[16] Osaka Med Ctr Canc & Cardiovasc Dis, Osaka, Japan

[17] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[18] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA

[19] Cook Cty Hosp, Chicago, IL 60612 USA

[20] Policlin Tor Vergata Univ, Rome, Italy

[21] Korea Canc Ctr Hosp, Seoul, South Korea

[22] Cedars Sinai Med Ctr, Samuel Oschin Comprehens Canc Inst, Los Angeles, CA 90048 USA

[23] Turku Univ, Cent Hosp, Turku, Finland

[24] Hosp Badalona Germans Trias & Pujol, Catalan Inst Oncol, Barcelona, Spain

[25] S Luigi Hosp, Turin, Italy

[26] Queens Univ, NCIC Clin Trials Grp, Kingston, ON, Canada

[27] Princess Margaret Hosp, Toronto, ON M4X 1K9, Canada

[28] Univ Coll London Hosp, London, England

[29] Tufts Med Ctr, Boston, MA USA

[30] EORTC Headquarters, Brussels, Belgium

[31] Osaka City Gen Hosp, Osaka, Japan

[32] Hyogo Coll Med, Nishinomiya, Hyogo, Japan

[33] Ist Ric Farmacol Mario Negri, Milan, Italy

[34] Kyoto Univ, Kyoto, Japan

[35] Glenfield Hosp, Leicester, Leics, England

[36] Sun Yat Sen Univ, Ctr Canc, Guangzhou 510275, Guangdong, Peoples R China

来源：

LANCET | 2010年 / 375卷 / 9722期

关键词：

RESECTED STAGE-I; VINORELBINE PLUS CISPLATIN; JAPAN STUDY-GROUP; RANDOMIZED-TRIAL; URACIL-TEGAFUR; THERAPY; SURGERY; UFT; VINDESINE; CARCINOMA;

D O I：

10.1016/S0140-6736(10)60059-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1267 / 1277

页数：11

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