Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints

Parmar, Mahesh; Torri, Valter; Stewart, Lesley

doi:10.1002/(sici)1097-0258(19981230)17:24<2815::aid-sim110>3.0.co;2-8

Cited by 4,390 publications

(2,526 citation statements)

References 14 publications

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“…When available, the HR was extracted directly from the papers. The standard errors of the HR estimates were calculated from the reported 95% confidence intervals (95% CI) or P values using the methods described by Parmar et al [19]. These values were analyzed using the generic inverse variance method.…”

Section: Statistical Pooling Of Study Resultsmentioning

confidence: 99%

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Ruiterkamp

Voogd

Bosscha

et al. 2009

Breast Cancer Res Treat

104

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According to current treatment standards, patients with metastatic breast cancer at diagnosis receive palliative therapy. Local treatment of the breast is only recommended if the primary tumor is symptomatic. Recent studies suggest that surgical removal of the primary tumor has a favorable impact on the prognosis of patients with primary metastatic breast cancer. We performed a systematic review of the literature to weigh the evidence for and against breast surgery in this patient group. Ten retrospective studies were found in which the use of breast surgery in primary metastatic breast cancer and its impact on survival was examined. The hazard ratios of the studies were pooled to provide an estimate of the overall effect of surgery, and the results and conclusions of the studies were analyzed. A crude analysis, without adjustment for potential confounders, showed that surgical removal of the breast lesion in stage-IV disease was associated with a significantly higher overall survival rate in seven of the ten studies, and a trend toward a better survival in the three remaining studies. Surgery of the primary tumor appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with hazard ratios ranging from 0.47 to 0.71. The pooled hazard ratio for overall mortality was 0.65 (95% CI 0.59-0.72) in favor of the patients undergoing surgery. This systematic review of the literature suggests that surgery of the primary breast tumor in patients with stage-IV disease at initial presentation does have a positive impact on survival. In order to provide a definite answer on whether local tumor control in patients with primary metastatic disease improves survival, a randomized controlled trial comparing systemic therapy with and without breast surgery is needed.

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Section: Statistical Pooling Of Study Resultsmentioning

confidence: 99%

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Ruiterkamp

Voogd

Bosscha

et al. 2009

Breast Cancer Res Treat

104

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“…In order to assess the role of NLR in predicting progression free survival (PFS) and overall survival (OS) of non-small cell lung cancer patients receiving Nivolumab, hazard ratios (HRs) for PFS, OS, and overall response rate (ORR) were used. If there was only survival curve without direct information about HR, the method provided by the referred protocol 24 was applied to calculate an indirect HR of interest. The subgroup analyses were also performed in terms of study design, disease stage, cutoff value, NLR testing time, and region.…”

Section: Methodsmentioning

confidence: 99%

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

Cao

et al. 2018

OncoImmunology

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Objective: Nivolumab has been used for treating non-small cell lung cancer (NSCLC) worldwide. Whether neutrophil-lymphocyte ratio (NLR) can predict the prognosis of NSCLC treated with Nivolumab is still under debate. This meta-analysis was to assess the significance of NLR as a predictive factor in NSCLC patients receiving Nivolumab.Methods: Databases including PubMed, Embase, and the Cochrane library were searched to identify eligible studies evaluating the role of NLR in predicting prognosis of NSCLC treated with Nivolumab until March 2018 without language restrictions. The meta-analysis was performed using hazard ratio (HR) of progression free survival (PFS) and overall survival (OS) in NSCLC patients with various NLR.Results: A total of 14 retrospective studies consisting of 1225 NSCLC patients were included. The combined results showed that relatively higher baseline NLR was associated with poor PFS (HR = 1.44; 95% confidence interval (CI):1.18–1.77; p < 0.05) and OS (HR = 1.75; 95% CI: 1.33–2.30; p < 0.05) after treatment of Nivolumab. Subgroup analysis suggested that NLR ≥ 5 was more reliable for PFS (HR = 1.73; 95%CI: 1.14, 2.62; p < 0.05) and OS (HR = 1.76; 95%CI: 1.47, 2.10; p < 0.05). In addition, post-treatment NLR also had predictive roles for PFS (HR = 3.17; 95%CI: 1.48, 6.82; p < 0.05) and OS (HR = 2.26; 95%CI: 1.05, 4.86; p < 0.05).Conclusion: Our findings suggest that NLR can be used as a prognostic biomarker for NSCLC treating with Nivolumab, and the recommended cutoff value of NLR is 5.

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“…Results of eligible studies were statistically synthesised if appropriate and possible. For time-to-event analyses, combined hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using formal methods for extracting summary statistics to perform meta-analyses of the published literature (Parmar et al, 1998). Heterogeneity between trial results was tested using the w 2 test and the I 2 measurement (Higgins et al, 2003).…”

Section: Methodsmentioning

confidence: 99%

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

2007

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The published literature comparing surgery, with or without adjuvant endocrine therapy, with endocrine therapy alone in older women with operable breast cancer was systematically reviewed.The design used is Cochrane review. Randomised controlled trials retrieved from the Cochrane Breast Cancer Group Specialised Register on 29 June 2005. Eligible studies recruited women aged 70 years or over with operable breast cancer, fit for surgery under general anaesthia. The studies compared surgery (either mastectomy or wide local excision, with or without endocrine therapy) to endocrine therapy alone. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Double data extraction and quality assessment were undertaken. Seven eligible trials were identified of which six had published time-to-event data. The quality of the allocation concealment was adequate in three studies and unclear in the remainder. In each case the endocrine therapy used was tamoxifen. When surgery alone was compared to endocrine therapy alone, there was no significant difference in OS (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.74 -1.30, P ¼ 0.9), but a significant difference in PFS (HR 0.55, 95% CI 0.39 -0.77, P ¼ 0.0006). When surgery with adjuvant endocrine therapy was compared to endocrine therapy alone, there was no significant difference in OS (HR 0.86, 95% CI 0.73 -1.00, P ¼ 0.06), but a significant difference in PFS (HR 0.65 (95% CI 0.53 -0.81, P ¼ 0.0001) for surgery plus endocrine therapy vs primary endocrine. The regimens have different side effect profiles with one study suggesting increased psychosocial morbidity at 3 months in the surgical arm, which resolves by 2 years. Primary endocrine therapy with tamoxifen is associated with inferior local disease control but noninferior survival to surgery for breast cancer in older women. Trials are needed to evaluate appropriate selection criteria for its use in terms of patient co-morbidity and quality of life. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for this population.

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Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints

Cited by 4,390 publications

References 14 publications

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

Impact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

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