A Cochrane review [Abstract] 1 included 7 trials with a total of 988 patients. Pre-operative chemotherapy increased survival (hazard ratio 0.82, 95% CI 0.69 to 0.97). This is equivalent to an absolute benefit of 6%, increasing overall survival across all stages of disease from 14% to 20% at 5 years.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions, e.g wide range of post-operative treatments) and by indirectness (patient level characteristics inconsistently reported making comparisons between the trials impossible; six of the seven RCTs were stopped early).
Primary/Secondary Keywords