Summary of findings for the main comparison. Breast surgery plus systemic treatment compared to systemic treatment for metastatic breast cancer.
| Breast surgery plus systemic treatment compared to systemic treatment for metastatic breast cancer | ||||||
| Patient or population: metastatic breast cancer Setting: inpatients and outpatients Intervention: breast surgery plus systemic treatment Comparison: systemic treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with systemic treatment | Risk with breast surgery plus systemic treatment | |||||
| Overall survival at 2 years Follow‐up: range 23 months to 40 months |
Study population | HR 0.83 (0.53 to 1.31) | 624 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | The estimates for the control group are based upon an average of the estimates from Badwe 2015 and Soran 2016. | |
| 511 per 1000 | 448 per 1000 (318 to 608) | |||||
| Quality of life | Not reported | Not reported | ‐ | ‐ | ‐ | |
| Local PFS at 2 years Follow‐up: range 23 months to 40 months |
Study population | HR 0.22 (0.08 to 0.57) | 607 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 4 | The estimates for the control group are based upon an average of the estimates from Badwe 2015 and Soran 2016. | |
| 500 per 1000 | 141 per 1000 (54 to 326) | |||||
| Distant PFS at 2 years Follow‐up: 23 months |
Study population | HR 1.42 (1.08 to 1.86) | 350 (1 RCT) | ⊕⊕⊕⊝ MODERATE 5 | The estimates for the control group are based upon the estimates from Badwe 2015. | |
| 548 per 1000 | 676 per 1000 (576 to 772) | |||||
| Breast cancer‐specific survival | Not reported | Not reported | ‐ | ‐ | ‐ | |
| Toxicity from local therapy Follow‐up: 40 months |
Study population | RR 0.99 (0.14 to 6.90) | 274 (1 RCT) | ⊕⊕⊝⊝ LOW 1 6 | The estimates for the control group are based upon the estimates from Soran 2016. | |
| 15 per 1000 | 15 per 1000 (2 to 101) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1In Soran 2016, trial random sequence generation and allocation concealment were unclear. Downgraded one level. 2Statistical or clinical heterogeneity, or both. Downgraded one level. 3Wide 95% CI (0.53 to 1.31) including the null effect. Downgraded one level. 4In Soran 2016, trial random sequence generation and allocation concealment were unclear. Outcome assessors were not blinded, and this is a subjective outcome. Downgraded one level. 5Outcome assessors were not blinded, and this is a subjective outcome. Downgraded one level. 6Very wide 95% CI (0.14 to 6.9). Downgraded one level.