Annals of Surgical Oncology

, Volume 19, Issue 11, pp 3343–3350 | Cite as

Efficacy of Adjuvant Chemotherapy after Surgery when Considered over all Cancer Types: A Synthesis of Meta-Analyses

  • Russell J. Bowater
  • Sally M. E. Abdelmalik
  • Richard J. Lilford
Healthcare Policy and Outcomes



Despite a large number of clinical trials having been conducted to assess the efficacy of adjuvant chemotherapy after surgery for various cancers, whether it is best to use this treatment remains a generally contentious issue for many common cancers. The purpose of this study was to ascertain whether any general conclusions can be drawn about the efficacy or inefficacy of this treatment within different cancer classifications.


Meta-analyses of randomized, controlled trials (RCTs) of adjuvant chemotherapy after surgery were synthesized over as many types of cancer as possible. Data sources were Medline, Embase, and the Cochrane library. Eligible meta-analyses were meta-analyses of RCTs for any type of cancer that compared surgery followed by adjuvant chemotherapy with surgery followed by no adjuvant chemotherapy.


The literature search found 25 meta-analyses for 15 cancer types that satisfied the criteria necessary for detailed analysis within this study. The estimates of relative risk for all cause mortality were reported as being less than one (indicating adjuvant chemotherapy is beneficial) by all meta-analyses apart from a meta-analysis for colorectal cancer metastasized to the liver. Moreover, 15 of these meta-analyses also reported that the 95 % confidence interval for this relative risk is less than one (indicating statistical significance at the 5 % level).


The results for all cancer types included in this study except for cancer metastasized to the liver can be thought of as supporting each other through the idea of there being a common treatment effect or at least a common range of effect across all (or most) of these cancer types. For example, with regard to cancer types where the evidence in favor of adjuvant chemotherapy after surgery is only moderately strong, the results of this study may encourage more clinicians to regard the use of this treatment as standard practice.


Relative Risk Adjuvant Chemotherapy Cancer Type Colorectal Liver Metastasis Metastatic Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Engineering and Physical Sciences Research Council of the UK through the MATCH Programme (Grant GR/S29874/01). RJB was also partially funded by PROMEP (El Programa de Mejoramiento del Profesorado) of Mexico.


  1. 1.
    Weissman DE, von Gunten CF. Fast Fact and Concept #99. Chemotherapy: response and survival data. 2nd edn. November 2007. End-of-Life/Palliative Education Resource Center (
  2. 2.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.PubMedCrossRefGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet. 2008;371(9606):29–40.CrossRefGoogle Scholar
  4. 4.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.CrossRefGoogle Scholar
  5. 5.
    Noguchi S, Koyama H, Uchino J, Abe R, Miura S, Sugimachi K, et al. Postoperative adjuvant therapy with tamoxifen, tegafur plus uracil, or both in women with node-negative breast cancer: a pooled analysis of six randomized controlled trials. J Clin Oncol. 2005;23(10):2172–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Gill S, Loprinzi CL, Sargent DJ, Thomé SD, Alberts SR, Haller DG, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22(10):1797–806.PubMedCrossRefGoogle Scholar
  7. 7.
    Sakamoto J, Hamada C, Rahman M, Kodaira S, Ito K, Nakazato H, et al. An individual patient data meta-analysis of adjuvant therapy with carmofur in patients with curatively resected colon cancer. Jpn J Clin Oncol. 2005;35(9):536–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Sakamoto J, Hamada C, Yoshida S, Kodaira S, Yasutomi M, Kato T, et al. An individual patient data meta-analysis of adjuvant therapy with uracil-tegafur (UFT) in patients with curatively resected rectal cancer. Br J Cancer. 2007;96(8):1170–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Zhao SL, Fang JY. The role of postoperative adjuvant chemotherapy following curative resection for gastric cancer: a meta-analysis. Cancer Invest. 2008;26(3):317–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Mathurin P, Raynard B, Dharancy S, Kirzin S, Fallik D, Pruvot FR, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther. 2003;17(10):1247–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Stocken DD, Büchler MW, Dervenis C, Bassi C, Jeekel H, Klinkenbijl JH, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005;92(8):1372–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Malthaner RA, Wong RK, Rumble RB, Zuraw L. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Med. 2004;2(35).Google Scholar
  13. 13.
    Winquist E, Oliver T, Gilbert R. Postoperative chemoradiotherapy for advanced squamous cell carcinoma of the head and neck: A systematic review with meta-analysis. Head Neck. 2007;29(1):38–46.PubMedCrossRefGoogle Scholar
  14. 14.
    Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE collaborative group. J Clin Oncol. 2008;26(21):3552–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Hamada C, Tanaka F, Ohta M, Fujimura S, Kodama K, Imaizumi M, et al. Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer. J Clin Oncol. 2005;23(22):4999–5006.PubMedCrossRefGoogle Scholar
  16. 16.
    Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data. Eur Urol. 2005;48(2):189–99.CrossRefGoogle Scholar
  17. 17.
    Elit L, Chambers A, Fyles A, Covens A, Carey M, Fung MF. Systematic review of adjuvant care for women with stage I ovarian carcinoma. Cancer. 2004;101(9):1926–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Stewart L, Burdett S, Glioma Meta-analysis Trialists (GMT) Group. Chemotherapy for high-grade glioma. Cochrane Database Syst Rev. 2002;(3):CD003913.Google Scholar
  19. 19.
    Verma S, Quirt I, McCready D, Bak K, Charette M, Iscoe N. Systematic review of systemic adjuvant therapy for patients at high risk for recurrent melanoma. Cancer. 2006;106(7):1431–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet. 1997;350(9092):1647–54.CrossRefGoogle Scholar
  21. 21.
    Nelson R, Freels S. Hepatic artery adjuvant chemotherapy for patients having resection or ablation of colorectal cancer metastatic to the liver. Cochrane Database Syst Rev. 2006;(4):CD003770.Google Scholar
  22. 22.
    Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRefGoogle Scholar
  23. 23.
    Portier G, Elias D, Bouche O, Rougier P, Bosset J-F, Saric J, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol. 2006;24(31):4976–82.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Russell J. Bowater
    • 1
  • Sally M. E. Abdelmalik
    • 2
  • Richard J. Lilford
    • 2
  1. 1.Department of MathematicsUniversidad Autónoma Metropolitana, Unidad IztapalapaMexico CityMexico
  2. 2.Department of Public Health, Epidemiology and BiostatisticsUniversity of BirminghamBirminghamUnited Kingdom

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