Table 3.7GRADE profile: In patients with clinical or pathological stage II and III rectal cancer, what is the effectiveness of adjuvant chemotherapy following surgery

Quality assessmentSummary of findings
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsAdjuvant ChemotherapycontrolRelative (95% CI)Absolute
Mortality (follow-up median 5.5 years1)
3randomised trialsserious2no serious inconsistencyno serious indirectnessno serious imprecisionnone181/1167 (15.5%)224/1095 (20.5%)HR 0.8 (0.69 to 0.92)37 fewer per 1000 (from15 fewer to 58 fewer)MODERATE
31.6%54 fewer per 1000 (from 21 fewer to 85 fewer)
Recurrence (follow-up median 5 years1)
3randomised trialsserious2no serious inconsistencyno serious indirectnessno serious imprecisionnone195/1167 (16.7%)3245/1163 (21.1%)3HR 0.77 (0.68 to 0.88)44 fewer per 1000 (from 23 fewer to 62 fewer)MODERATE
0%0 fewer per 1000 (from 0 fewer to 0 fewer)
39.4%74 fewer per 1000 (from 38 fewer to 105 fewer)
1

The median follow-up from three studies was at least five years but ranged from 0–10.9 years.

2

Lack of clarity in the individual trials regarding factors such as concealment and bias

3

The total events for one study were not reported, however as the HR was not calculated using this missing data does not impact the overall results.

From: 3, Management of local disease

Cover of Colorectal Cancer
Colorectal Cancer: The Diagnosis and Management of Colorectal Cancer.
NICE Clinical Guidelines, No. 131.
National Collaborating Centre for Cancer (UK).
Copyright © 2011, National Collaborating Centre for Cancer.

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