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Quimioterapia adyuvante para el cáncer de pulmón de células no pequeñas en estadio inicial resecado
Sarah Burdett, Jean Pierre Pignon, Jayne Tierney, Helene Tribodet, Lesley Stewart, Cecile Le Pechoux, Anne Aupérin, Thierry Le Chevalier, Richard J Stephens, Rodrigo Arriagada, Julian PT Higgins, David H Johnson, Jan Van Meerbeeck, Mahesh KB Parmar, Robert L Souhami, Bengt Bergman, Jean‐Yves Douillard, Ariane Dunant, Chiaki Endo, David Girling, Harubumi Kato, Steven M Keller, Hideki Kimura, Aija Knuuttila, Ken Kodama, Ritsuko Komaki, Mark G Kris, Thomas Lad, Tommaso Mineo, Steven Piantadosi, Rafael Rosell, Giorgio Scagliotti, Lesley K Seymour, Frances A Shepherd, Richard Sylvester, Hirohito Tada, Fumihiro Tanaka, Valter Torri, David Waller, Ying Liang, for the Non‐Small Cell Lung Cancer Collaborative Group | 2 marzo 2015

Respuestas clínicas Cochrane

Topics

Temas

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Overall survival.
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Figure 3

Overall survival.

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PORT effect on overall survival by trial according to stage.
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Figure 4

PORT effect on overall survival by trial according to stage.

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Hazard ratio (HR) for the interaction between the effect of PORT on survival and (a) stage or (b) nodal status.
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Figure 5

Hazard ratio (HR) for the interaction between the effect of PORT on survival and (a) stage or (b) nodal status.

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Sensitivity analysis 1: only trials with all stage subgroups included.
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Figure 6

Sensitivity analysis 1: only trials with all stage subgroups included.

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Sensitivity analysis (2): only trials with stage II and III subgroups represented.
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Figure 7

Sensitivity analysis (2): only trials with stage II and III subgroups represented.

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PORT effect on overall survival by trial according to nodal status.
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Figure 8

PORT effect on overall survival by trial according to nodal status.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 1 Survival.
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Analysis 1.1

Comparison 1 Surgery + PORT versus surgery alone, Outcome 1 Survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 2 Local recurrence‐free survival.
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Analysis 1.2

Comparison 1 Surgery + PORT versus surgery alone, Outcome 2 Local recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 3 Distant recurrence‐free survival.
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Analysis 1.3

Comparison 1 Surgery + PORT versus surgery alone, Outcome 3 Distant recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 4 Recurrence‐free survival.
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Analysis 1.4

Comparison 1 Surgery + PORT versus surgery alone, Outcome 4 Recurrence‐free survival.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 5 RT delivery method.
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Analysis 1.5

Comparison 1 Surgery + PORT versus surgery alone, Outcome 5 RT delivery method.

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Comparison 1 Surgery + PORT versus surgery alone, Outcome 6 RT dose.
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Analysis 1.6

Comparison 1 Surgery + PORT versus surgery alone, Outcome 6 RT dose.

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Table 1. Common meta‐analysis stage scale (original analyses ‐ based on TNM 4th edition)

T stage

N stage

M stage

Meta‐analysis stage

AJCC stage

0, 1, 2, X, iS

0

0

I

I

0, 1, 2, X, iS

1

0

II

II

Any

2, 3

0

III

III non‐metastatic

3, 4

Any

0

III

III non‐metastatic

Any

Any

1

IV

Any metastatic

AJCC = American Joint Committee on Cancer.
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Table 1. Common meta‐analysis stage scale (original analyses ‐ based on TNM 4th edition)
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Table 2. Common meta‐analysis stage scale (current analysis ‐ based on TNM 6th edition)

T stage

N stage

M stage

Meta‐analysis stage

1, 2

0

0

I

1, 2

1

0

II

3

0

0

II

1, 2

2

0

III

3

1, 2

0

III

Any

Any

1

IV
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Table 2. Common meta‐analysis stage scale (current analysis ‐ based on TNM 6th edition)
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Table 3. Characteristics of participants in PORT meta‐analysis

Characteristic

Postoperative RT

Surgery only

Total

AGE (data from 11 trials)

< 54 years

294

327

621

55 to 59 years

267

261

528

60 to 64 years

290

276

566

> 65 years

312

315

627

Unknown

0

1

1

SEX (data from 11 trials)

Male

988

992

1980

Female

175

187

362

Not recorded

0

1

1

HISTOLOGY (data from 9 trials)

Adenocarcinoma

195

218

413

Squamous

522

545

1067

Other

66

54

120

Unknown

380

363

743

META‐ANALYSIS STAGE (data from 11 trials)

I

328

338

666

II

353

366

719

III

463

455

918

IV

1

0

1

Unknown

18

21

39

WHO PERFORMANCE STATUS (data from 4 trials; not used)

Good (0, 1)

195

196

391

Poor (2, 3, 4)

77

83

160

Unknown

22

21

43
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Table 3. Characteristics of participants in PORT meta‐analysis
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Table 4. Changes in results over time

Trend or interaction

1998

Trend or interaction

2005

Trend or interaction

2010 'old' methods

Trend or interaction

2010 'new' methods

and TNM changes

Age

P = 0.34

P = 0.44

P = 0.32

P = 0.20

Sex

P = 0.94

P = 0.92

P = 0.84

P = 0.49

Histology

P = 0.75

P = 0.61

P = 0.42

P = 0.38

Stage

P = 0.0003

P = 0.003

P = 0.003

P = 0.12

Nodal status

P = 0.016

P = 0.02

P = 0.03

P = 0.39
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Table 4. Changes in results over time
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Comparison 1. Surgery + PORT versus surgery alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.18 [1.07, 1.31]

2 Local recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.12 [1.01, 1.23]

3 Distant recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.13 [1.02, 1.24]

4 Recurrence‐free survival Show forest plot

11

2343

Hazard Ratio (95% CI)

1.10 [0.99, 1.21]

5 RT delivery method Show forest plot

11

2343

Hazard Ratio (95% CI)

1.18 [1.07, 1.31]

5.1 Cobalt‐60 only

1

202

Hazard Ratio (95% CI)

1.48 [1.09, 2.02]

5.2 Cobalt‐60 and linac

6

1746

Hazard Ratio (95% CI)

1.18 [1.05, 1.33]

5.3 Linac only

4

395

Hazard Ratio (95% CI)

1.02 [0.80, 1.31]

6 RT dose Show forest plot

11

2343

Peto Odds Ratio (95% CI)

1.18 [1.07, 1.31]

6.1 < 45 Gy

2

382

Peto Odds Ratio (95% CI)

0.93 [0.75, 1.17]

6.2 ≥ 45 Gy

9

1961

Peto Odds Ratio (95% CI)

1.25 [1.12, 1.40]
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Comparison 1. Surgery + PORT versus surgery alone
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