Critical appraisal:Huang X, Wang J, Chen Q, Jiang J 2014

Critical Appraisal

Article being appraised

Huang X, Wang J, Chen Q, Jiang J. Mediastinal Lymph Node Dissection versus Mediastinal Lymph Node Sampling for Early Stage Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. PLoS One 2014;9(10):e109979 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25296033.

Applicable clinical question

• Does complete mediastinal lymph node dissection improve overall survival compared to mediastinal lymph node staging in stage I NSCLC?
• Does complete mediastinal lymph node dissection improve overall survival compared to mediastinal lymph node staging in stage II NSCLC?
• What is the clinical benefit of mediastinal lymph node dissection in stage IIIA operable NSCLC?

Key Facts

Study Design

systematic review

Number of Patients:

1791

Reported outcome(s):

overall survival, local recurrence rate, distant metastasis rate, total complications rate

Results of outcome(s):

overall survival (HR = 0.77, 95% CI 0.55 to 1.08; P = 0.13)
local recurrence rate (RR = 0.93, 95% CI 0.68 to 1.28; P = 0.67)
distant metastasis rate (RR = 0.88, 95% CI 0.74 to 1.04; P = 0.15)
total complications rate (RR = 1.10, 95% CI 0.67 to 1.79; P = 0.72)

Comments on results:

Conclusions can only be drawn for Stage I or very early stage resectable non-small cell cancer with no clinical or surgical evidence of lymph node involvement.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias

Low risk of bias

Comments:

Show/Hide Risk of bias assessment

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?

No

Size of effect

3	Reason for decision:

Relevance of evidence

1	Additional comments:

Result of appraisal

Included

Completed by

Associate Professor Gavin Wright MD FRACS PhD

This appraisal has been completed.

Article

Huang X, Wang J, Chen Q, Jiang J. Mediastinal Lymph Node Dissection versus Mediastinal Lymph Node Sampling for Early Stage Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. PLoS One 2014;9(10):e109979 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25296033.

Assigned to

User:Gavin.wright

Topic area

Guidelines:Lung cancer/Treatment/Non-small-cell stage I operable

Clinical question

• Does complete mediastinal lymph node dissection improve overall survival compared to mediastinal lymph node staging in stage I NSCLC?
• Does complete mediastinal lymph node dissection improve overall survival compared to mediastinal lymph node staging in stage II NSCLC?
• What is the clinical benefit of mediastinal lymph node dissection in stage IIIA operable NSCLC?

Form

Form:Critical appraisal

Study design

systematic review

Level of Evidence

I

Section below only relevant for Cancer Council Project Officer

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