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. 2017 Aug 29;2017(8):CD004064. doi: 10.1002/14651858.CD004064.pub4

Summary of findings 2. Combination versus single‐agent chemotherapy for advanced gastric cancer.

Combination versus single‐agent chemotherapy for advanced gastric cancer
Patient or population: people with advanced gastric cancer
 Settings: outpatient clinics participating in international multicentre studies
 Intervention: combination
Control: single‐agent chemotherapy
Outcomes Illustrative comparative risks* (95% CI) Relative effect
 (95% CI) No of Participants
 (studies) Quality of the evidence
 (GRADE) Comments
Assumed risk Corresponding risk
Single‐agent chemotherapy Combination
Overall survival Study population HR 0.84 
 (0.79 to 0.89) 4447
 (23) ⊕⊕⊕⊝
 moderate1 Weighted average of median survival durations from included studies

  • 10.5 months in studies published after year 2000

  • 6.4 months in studies published before year 2000

  • 11.6 months in studies published after year 2000

  • 7.3 months in studies published before year 2000
Tumour response Study population OR 2.30 
 (1.94 to 2.72) 2833
 (18) ⊕⊕⊕⊕
 high1  
226 per 1000 402 per 1000 
 (361 to 442)
Moderate
231 per 1000 409 per 1000 
 (368 to 450)
Time to progression Study population HR 0.69 
 (0.55 to 0.87) 720
 (4) ⊕⊕⊕⊝
 moderate1 Weighted average of median survival durations from included studies
2.8 months 4.1 months
Treatment‐related death Study population OR 1.64 
 (0.83 to 3.24) 3876
 (18) ⊕⊕⊝⊝
 moderate2  
5 per 1000 9 per 1000 
 (4 to 17)
Moderate
0 per 1000 0 per 1000 
 (0 to 0)
*For time‐to‐event outcomes, e.g. overall survival, the assumed and corresponding risks were obtained by calculating the weighted average of the median survival durations reported in included studies. For dichotomous outcomes, the assumed and corresponding risks (and their 95% confidence interval) are based on proportions of events in the control and intervention groups respectively.
 CI: Confidence interval; OR: Odds ratio; HR: Hazard ratio;
GRADE Working Group grades of evidence
 High quality: Further research is very unlikely to change our confidence in the estimate of effect.
 Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
 Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
 Very low quality: We are very uncertain about the estimate.

1 Downgraded by one level for risk of bias.
 2 Downgraded by two levels for serious imprecision.