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Meta-Analysis
. 2013 Jan 15;108(1):39-48.
doi: 10.1038/bjc.2012.516. Epub 2012 Nov 22.

Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary: a systematic review and meta-analysis

J Lee  1 , S Hahn, D-W Kim, J Kim, S N Kang, S Y Rha, K B Lee, J-H Kang, B-J Park
Affiliations
Meta-Analysis

Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary: a systematic review and meta-analysis

J Lee et al. Br J Cancer. .

Abstract

Background: Although chemotherapeutic regimens containing a taxane or platinum agent have been widely recommended for unfavourable carcinoma of unknown primary (CUP), no evidence exists for the superiority of any administered regimens. To date, the efficacy has been mostly assessed in the limited setting of phase II trials, and few attempts have been made to synthesise all available data for survival outcomes.

Methods: Electronic databases were searched from 1980 to 2011. Survival results were combined for each pre-specified category of regimens using a random-effects model, and meta-regression models were used to adjust for heterogeneity in some known prognostic factors.

Results: A total of 32 studies were included for meta-analysis. Tendency towards better survival outcome by platinums or taxanes was indicated. After adjustment for important prognostic factors, however, the difference between the platinum-based and non-platinum regimens became no longer significant. Survival benefits by the taxane-based regimens remained significant, with a prolonged median survival time of 1.52 months (P=0.03) and a higher 1-year survival rate of 6.25% (P=0.05), but the benefit did not sustain for 2 years.

Conclusion: Although no effective therapies have been established, this meta-analysis helps to fill an important gap of evidence. However, caution should still be taken because of the potential unmeasured confounding.

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Figures

Figure 1
Figure 1
Flow chart of literature selection.
Figure 2
Figure 2
Combined estimates for the survival by treatment strategy. χ2, chi-squared statistics; n, the number of studies that were included to the regimen groups, I2, I-squared statistics; P1, platinum; P0, no platinum; T1, taxane; T0, no taxane; P1T1, platinum and taxane; P1T0, platinum and no taxane; P0T1, no platinum and taxane; P0T0, no platinum and no taxane; P-value is for the χ2 test.
Figure 3
Figure 3
Comparison of survival rates from the randomised controlled clinical trials. The hazard ratio above 1 means that the risk of death by the first regimen is higher than that by the second regimen. nA, number of patients in the treatment A; nB, number of patients in the treatment B.
Figure 4
Figure 4
Funnel plot for evaluation of the small trial effect for survival. The fitted line corresponds to the regression test for funnel plot asymmetry proposed by Egger et al (1997).
See this image and copyright information in PMC

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