Critical appraisal:Burdett S, Pignon JP, Tierney J, Tribodet H, Stewart L, Le Pechoux C, et al 2015

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Critical Appraisal

Article being appraised

Burdett S, Pignon JP, Tierney J, Tribodet H, Stewart L, Le Pechoux C, et al. Adjuvant chemotherapy for resected early-stage non-small cell lung cancer. Cochrane Database Syst Rev 2015 Mar 2;3:CD011430 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25730344.


Applicable clinical question

Key Facts

Study Design

systematic review — Only randomised trials were included

Study aims:

Evaluate benefit of adjuvant chemotherapy when given after surgery alone or after surgery and radiotherapy for early stage NSCLC

Number of Patients:

11107

Very few stage IA patients were included in the non-tegafur studies
Various chemotherapy regimens were used - mainly cisplatin based.
Reported outcome(s):

Absolute benefit of 4% through the addition of chemotherapy to surgery early stage NSCLC - HR 0.86, p < 0.0001
Absolute benefit of 4% through the addition of chemotherapy to surgery plus RT in early stage NSCLC, HR 0.88, p=0.009

Results of outcome(s):

Adjuvant chemo provides a survival benefit in resected stage IB, II and III NSCLC - but the benefit in stage IA disease was not evident

Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias
Low risk of bias Comments: Well performed systematic review

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
Yes – pre-specified inclusion criteria applied independently by two people
Were the studies assessed for quality (relating to the minimisation of biases)?
Yes – appropriate quality issues were assessed independently by two people
Were the characteristics and results of individual studies appropriately summarised?
Yes – summary descriptive tables of subjects, interventions, outcomes etc are provided and estimates of treatment effect displayed
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
Yes
If there was heterogeneity, were sources of heterogeneity explored?
Yes
Size of effect
4 Reason for decision: Stage IA disease effect has a wide CI that crosses 1 with a HR that is over 1. Stage IB benefit is more convincing.
Relevance of evidence
1 Additional comments: Survival was the primary outcome. Well conducted systematic review. Little evidence to support stage IA decisions as sample size was small.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Christos Karapetis


Jutta's tick icon.png This appraisal has been completed.


Article
Burdett S, Pignon JP, Tierney J, Tribodet H, Stewart L, Le Pechoux C, et al. Adjuvant chemotherapy for resected early-stage non-small cell lung cancer. Cochrane Database Syst Rev 2015 Mar 2;3:CD011430 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25730344.
Assigned to
User:Chris.karapetis
Topic area
Guidelines:Lung cancer/Treatment/Non-small-cell stage I operable
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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