Surgery (S) and radiotherapy (RT) plus adjuvant chemotherapy (CT) versus surgery and radiotherapy in non-small cell lung cancer (NSCLC): A meta-analysis using individual patient data (IPD) from randomised clinical trials (RCTs)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7521-7521 ◽  
Author(s):  
C. Le Pechoux ◽  
H. Tribodet ◽  
J. P. Pignon ◽  
S. Burdett
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Meta Analysis ◽  
Alkylating Agents ◽  
Vinca Alkaloid ◽  
Distant Recurrence ◽  
Rank Test ◽  
Incomplete Resection ◽  
Number Of Patients ◽  
Future Policy

7521 Background: Our previous IPD meta-analysis of CT (BMJ 1995;311:899) suggested that CT may have a role in the treatment of various stages of NSCLC. However, the results in the S + RT setting were uncertain because of the small number of patients in this setting. We have updated this meta-analysis, including trials and outcomes not available in 1995. We report here on the effectiveness of S+RT+CT compared to S+RT. Methods: Systematic searches for RCTs were followed by the central collection, checking and re-analysis of updated IPD. Results from individual trials were combined using the stratified (by trial) log rank test to calculate pooled hazard ratios (HRs). Previously included old trials using long-term alkylating agents were excluded from this analysis. Results: IPD were obtained from 2,626 patients (12% with incomplete resection) from 11 RCTs. This represents 86% of all known randomised patients and adds a further 5 trials and 1,956 patients to the 1995 analyses. Median follow-up is 6.3 years. Ten trials used sequential RT-CT. 8 RCTs used cisplatin + vinca alkaloid/ etoposide, 1 used cisplatin + tegafur and 2 used other platinum regimens. There is a significant benefit of CT on survival (HR=0.88, 95% CI=[0.80–0.96], p=0.0062), with an absolute benefit of 4.7% (from 29% to 34%) at 5 years. The HRs for older (0.93 [0.79–1.10]) and more recent trials (0.89 [0.81–0.97]) were comparable (test for interaction p=0.49). Results were similar for recurrence-free survival (0.84, [0.77–0.93], p=0.0006), local (0.79 [0.67–0.94], p=0.0075) and distant recurrence-free interval (0.75 [0.66–0.87], p<0.0001) (data available for 7 trials). There was no clear evidence of a difference in effect by type of CT given. Also, there was no clear evidence that any patient subgroup defined by age, sex or stage benefited more or less from CT. Conclusion: These results demonstrate now a benefit of adjuvant chemotherapy in resected lung cancer associated with radiotherapy. These results are very similar to those of the meta-analysis without radiotherapy. They provides robust estimates for future policy and research. Unrestricted grants from PHRC, LNCC and sanofi-aventis. [Table: see text]

Surgery and adjuvant chemotherapy (CT) compared to surgery alone in non-small cell lung cancer (NSCLC): A meta-analysis using individual patient data (IPD) from randomized clinical trials (RCT)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7552-7552 ◽  
Author(s):  
L. A. Stewart ◽  
S. Burdett ◽  
J. F. Tierney ◽  
J. Pignon
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Alkylating Agents ◽  
Distant Recurrence ◽  
Rank Test ◽  
Patient Subgroup ◽  
Resected Nsclc ◽  
Hazard Ratios ◽  
Future Policy ◽  
Treatment Comparisons

7552 Background: A previous IPD meta-analysis (BMJ 1995;311:899) that suggested CT may have a role in the treatment of NSCLC has been updated. This includes RCTs, regimens and outcomes that were not available in 1995. The meta-analysis examines the role of CT in 7 treatment comparisons. Here we report on the effectiveness of surgery plus adjuvant CT compared with surgery alone. Methods: We conducted a systematic search for RCTs followed by the central collection, checking and re-analysis of updated IPD. Results from RCTs were combined using the stratified (by trial) log rank test to calculate individual and pooled hazard ratios (HRs). Previously included RCTs using long-term alkylating agents were excluded from this analysis due to their antiquity. Results: IPD were obtained on 8147 patients from 30 RCTs. 15 RCTs used a cisplatin combination without Tegafur/Tegafur+Uracil (UFT), 8 RCTs used Tegafur/UFT without cisplatin and 7 RCTs used Tegafur/UFT and cisplatin. This represents 95% of all known randomised patients and adds 18 trials and 5835 patients to the 1995 analyses. The results show a highly significant benefit of CT on survival (HR=0.86 95% CI 0.81–0.93, p<0.000001), with an absolute benefit of 4% (from 60% to 64%) at 5 years. Results were similar for recurrence-free survival and time to distant recurrence, but there was a larger effect on time to local recurrence ( Table ). There was no clear difference in effect by type of CT given. There was no clear evidence that any patient subgroup defined by age, sex or histology benefited more or less from CT. There was a suggestion of a trend in effect by stage (p=0.047), this will be explored further. Conclusion: The results demonstrate conclusively and consistently a benefit of adjuvant CT in resected NSCLC, irrespective of the regimen used, the patient subgroup treated or the endpoint assessed, thus providing reliable estimates on which to base future policy and research. [Table: see text] [Table: see text]

Surgical Results in Pathological N1 Nonsmall Cell Lung Cancer

2020 ◽  
Author(s):  
Yukihiro Yoshida ◽  
Masaya Yotsukura ◽  
Kazuo Nakagawa ◽  
Hirokazu Watanabe ◽  
Noriko Motoi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cell Lung Cancer ◽  
Nonsmall Cell Lung Cancer ◽  
Distant Recurrence ◽  
Rank Test ◽  
Log Rank Test ◽  
Single Station ◽  
Positive Lymph Nodes

Abstract Background This retrospective study investigated the prognosis of patients with pathological N1 (pN1) nonsmall cell lung cancer (NSCLC). Methods We included patients with pN1 NSCLC who underwent lobectomy or pneumonectomy with mediastinal lymph node dissection and achieved complete resection (R0) between January 2000 and December 2012. Patients who received neoadjuvant therapy were excluded. Results A total of 249 patients were included. The mean age was 63.2 years, and 172 patients were males. Of the 249 patients, 200, 20, and 29 underwent lobectomy, bilobectomy, and pneumonectomy, respectively. The median observation period was 5.5 years. The 5-year overall survival (OS) rate was 64.6% (95% confidence interval: 58.3–70.4). Five-year OS rates were 79.8% for positive lymph nodes at station 13 or 14 (n = 57), 59.6% at station 12 (n = 72), 62.7% at station 11 (n = 69), and 56.9% at station 10 (n = 51) (log-rank test; p = 0.016); furthermore, the 5-year OS rate was 75.2% for patients with positive lymph nodes at a single station (n = 160) and 45.4% for patients with positive lymph nodes at multiple stations (n = 89) (log-rank test; p < 0.001). Five-year cumulative incidences of recurrence were equivalent between patients who received adjuvant chemotherapy and patients who did not (45.9 vs. 55.1%; Gray's test; p = 0.366). Distant recurrence was the most frequent mode of recurrence in both groups (70.8 and 67.3%). Conclusion The locations and the number of stations of the positive lymph nodes were identified as prognostic factors in patients with pN1 NSCLC. The primary mode of recurrence was distant recurrence irrespective of postoperative adjuvant chemotherapy.

scholarly journals Pattern of recurrence of pN2 non-small-cell lung cancer: should postoperative radiotherapy be reconsidered?

2020 ◽  
Vol 59 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Kazuo Nakagawa ◽  
Yukihiro Yoshida ◽  
Masaya Yotsukura ◽  
Shun-ichi Watanabe
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Postoperative Radiotherapy ◽  
Distant Recurrence ◽  
Small Cell ◽  
Small Cell Lung ◽  
Nodal Dissection ◽  
Systematic Nodal Dissection ◽  
Pattern Of Recurrence

Abstract OBJECTIVES The prognosis of patients with mediastinal lymph node (LN) metastasis (pN2 stage III disease) is still unsatisfactory. Both systemic and local recurrence should be prevented after curative surgery. The aim of this study was to explore the pattern of recurrence in patients with completely resected pN2 non-small-cell lung cancer (NSCLC) in the era of adjuvant chemotherapy. METHODS We investigated 337 patients with completely resected cN0-1 and pN2 NSCLC from 2005 to 2016 at National Cancer Center Hospital, Japan. The patterns of recurrence were compared between patients who were managed by observation alone and those with adjuvant chemotherapy. In patients with regional LN recurrence, the pattern and site of recurrence were also explored. RESULTS There were 195 (58.5%) men and 142 (41.5%) women with a mean age of 63.2 years. Fifty-five (16.3%) patients developed only regional LN recurrence, 116 (32.6%) patients developed only distant recurrence and 65 (19.3%) patients developed both regional LN recurrence and distant recurrence. The difference in the pattern of recurrence between patients with observation alone and those with adjuvant chemotherapy was not statistically significant (P = 0.145). As for the pattern of regional LN recurrence, 68 (20.2%) patients had LN recurrence inside the systematic nodal dissection area. CONCLUSIONS Regional LN recurrence was observed in &gt;30% of patients with completely resected pN2 NSCLC. About 20% of patients had recurrence inside the systematic nodal dissection area. Postoperative radiotherapy might be considered as an additional treatment strategy for these patients.

Adjuvant Chemotherapy for Lung Cancer: Cisplatin Doublets Only?

2008 ◽  
Vol 6 (3) ◽  
pp. 277-284 ◽  
Author(s):  
Daniel Morgensztern ◽  
Ramaswamy Govindan
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Recurrent Disease ◽  
Meta Analysis ◽  
Expression Studies ◽  
Gene Expression Studies ◽  
Near Future ◽  
Related Mortality ◽  
Selection Of

Lung cancer is the leading cause of cancer-related mortality world-wide. Despite adequate resection, more than half of patients die of recurrent disease, usually at distant sites. Adjuvant systemic chemotherapy is mainly used to eradicate micrometastatic disease. Since the seminal 1995 meta-analysis from earlier studies showed a trend toward improved survival with the use of cisplatin-based adjuvant chemotherapy, several randomized prospective adjuvant trials have addressed this question and eventually established the role for platinum-based adjuvant chemotherapy in patients with stage II or IIIA non–small cell lung cancer who have undergone complete resection. The role of adjuvant chemotherapy in patients with stage I disease remains controversial. Although no clinical or molecular predictors of recurrent disease after surgical resection are reliable, encouraging preliminary data on gene expression studies suggest that identifying, and perhaps treating, only patients at high risk for relapse might be possible in the near future. Furthermore, molecular predictors of resistance may guide the selection of chemotherapy in this setting.

scholarly journals Benefit of adjuvant chemotherapy for patients with stage IB non-small cell lung cancer: a systematic review and meta-analysis

2021 ◽  
Vol 9 (18) ◽  
pp. 1430-1430
Author(s):  
Xiaofan Wang ◽  
Donglai Chen ◽  
Junmiao Wen ◽  
Yiming Mao ◽  
Xuejuan Zhu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Ib

scholarly journals Meta-analysis of adjuvant chemotherapy versus surgery alone in T2aN0 stage IB non-small cell lung cancer

2018 ◽  
Vol 14 (1) ◽  
pp. 139 ◽  
Author(s):  
Shaofa Xu ◽  
Tianxiang Zhang ◽  
Qiang Guo ◽  
Ye Zhang ◽  
Zhidong Liu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Ib

scholarly journals Associations between I/D polymorphism in the ACE gene and lung cancer: an updated systematic review and a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junjian Chen ◽  
Mao Sun ◽  
Min Zhou ◽  
Renfu Lu
Keyword(s):  
Lung Cancer ◽  
Cancer Risk ◽  
Lung Cancer Risk ◽  
Meta Analysis ◽  
Case Control ◽  
Rank Test ◽  
Case Control Studies ◽  
Funnel Plot ◽  
Random Ratio ◽  
Q Statistic

Abstract Background We evaluated the association between the I/D polymorphism in the ACE gene and lung cancer risk by performing a meta-analysis. Methods The heterogeneity in the study was tested using the Cochran χ2-based Q statistic test and I2 test, and then the random ratio or fixed effect was utilized to merge the odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the strength of the association between ACE polymorphisms and susceptibility to lung cancer. Sensitivity analysis was also performed. Using funnel plot and Begg’s rank test, we investigated the publication bias. All statistical analyses were performed using Stata 12.0 and RevMan 5.3. Results A total of 4307 participants (2181 patients; 2126 controls) were included in the 12 case–control studies. No significant association was found between the ACE I/D polymorphism and lung cancer risk (II vs. ID + DD: OR = 1.22, 95% CI = 0.89–1.68; II + ID vs. DD: OR = 1.21, 95% CI = 0.90–1.63; I vs. D: OR = 1.15, 95% CI = 0.95–1.39). In the subgroup analysis by ethnicity, no significant association between the ACE I/D polymorphism and lung cancer risk was found among Asian and Caucasian populations for the comparisons of II vs. ID + DD, II + ID vs. DD, and I vs. D genetic models. Conclusion The ACE I/D polymorphism is not associated with the risk of lung cancer.

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